Driving Application Form Side Navigation Students and other non-employees requesting to drive a fleet vehicle must submit the hard copy Driving Application Form (.doc) to receive authorization. The application must be completed and submitted to Physical Plant along with a copy of your current drivers license for approval. Fleet Safety Policy Students must complete a new application when driving for multiple departments and must be renewed every semester. When requesting a 14 passenger mini bus, you must schedule a time to test drive before your approved trip. Please contact Jane Taylor at 535-7351 to schedule a time with the Grounds Supervisor, Craig Johnson.Employment Status*FacultyStaffYou are not eligible for online application The online driver application can only be completed by faculty or staff. You must download and submit a hard copy driver application form to the physical plant office. IdentificationName* First Last Goshen College ID #*Drivers License State*(Driver's license must be valid in the U.S.)Birth Date* Driving Record, Experience & Health QuestionsDo you have 2 years regular (almost daily) driving experience?*YesNoHave you had auto insurance refused, cancelled, or expired in the last five years?*YesNoHave you had a suspended or revoked operator’s license in the past five years?*YesNoHave you ever been arrested and detained?*YesNoDo you take any medications that may cause drowsiness?*YesNoDo you have any physical impairment?*YesNoDo you have heart disease, epilepsy, or diabetes?*YesNoPlease list the medication prescribed:*How long has the problem been controlled medically?*Have you, while driving a motor vehicle, been involved in an accident during the past 5 years?*YesNoList all accidents regardless of who was at fault and approximate dates they occurred.* Have you received any speeding or other traffic violation tickets in the past three years?*YesNoPlease list the date(s) and violation(s)* Terms and Conditions Capital Violations: If you, (the student driver) has one or more of the following violations within the last 5 years you are not qualified to drive a Goshen College vehicle: Driving while intoxicated or impaired or under the influence of drugs. Criminal conviction with a motor vehicle (e.g. felony, hit and run, negligent homicide). Speed in excess of 25 MPH over the speed limit. Major Violations: These are serious violations incurred at a high frequency that indicate a disregard for public safety. If you have had any of these violations in the last 3 years you are not qualified to drive a Goshen College vehicle: Any combination of three or more moving violations, “At Fault Accidents” or “Preventable Accidents”. Driving with a suspension, revocation or administrative restriction. Leaving the scene of an accident as defined by state laws. Reckless driving. Other Violations: If you have had any combination of two or more moving violations, “At Fault Accidents” or “Preventable Accidents” in the last 12 months you are not qualified to drive. Important Information for drivers of Goshen College Vehicles: You will find the Vehicle Insurance Card in the glove compartment. You will find the vehicle registration card in the glove compartment. Before moving the vehicle make sure all passengers have seatbelts securely in place. Cell Phone Usage: Goshen College forbids the use of cellphones while driving during BOTH of the following situations: ANY driver driving a Goshen College vehicle may not use a cell phone while driving. A Goshen College-reimbursed cell phone may not be used by the driver when driving ANY vehicle. Note that by signing below the user of a Goshen College vehicle agrees to abide by the above requirements at all times. Cell phone calls must be initiated or answered by the driver ONLY while the vehicle is parked in a safe location, and not in operation. I represent the above to be true and valid statements and I further authorize Goshen College to make an inquiry of my driving record, as deemed appropriate. I will notify Physical Plant Office if there is a change in my driving record or health condition that affects my qualification to drive. I will personally be driving the vehicle that was assigned to me. I will not loan the car to anyone else to drive.* I have read, understand, and agree to follow the policies related to driving a college vehicle.