CERTIFICATION CHECKLIST



BUTTE COUNTY FIRE DEPARTMENT

AUTHORIZATION TO DRIVE FORM

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|NAME (Last, First) | |COMPANY # | |DATE | |

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|Authorization to Drive |

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My signature below indicates I have reviewed the above VFF’s driving record and approve this request.

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|Battalion Chief | |Date |

My signature below indicates the individual listed above has met the training and experience requirements to operate the requested fire apparatus

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|Training Bureau Battalion Chief | |Date |

This form will be placed in the employees training file in the Training & Safety Bureau.

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DRIVER’S䰠䍉久䕓丠䵕䕂㩒彟彟彟彟彟彟彟彟彟†䐠噍䰠䍉久䕓䌠䕈䭃἟彟⽟彟⽟彟ൟ䴪獵⁴牰癯摩⁥⁡畣牲湥⁴䵄⁖牰湩潴瑵⠠畃牲湥⁴楷桴湩㌠‰慤獹ഩठ䴠獵⁴牰癯摩⁥畣牲湥⁴䅃䐠楲敶鉲⁳楌散獮⁥潣祰⨍畍瑳瀠潲楶敤挠牵敲瑮愠瑵浯瑯癩⁥湩畳慲据⁥潰楬祣䔍偘剉呁佉⁎䅄䕔›彟彟弯彟⽟彟彟य़ ††उ漪汮⁹敲畱物摥映牯渠睥瘠汯湵整牥愠灰楬慣楴湯഍䱃十⁓䙏䰠䍉久䕓›彟彟彟彟彟彟഍

܇䤍爠煥敵瑳琠慨⁴祭搠楲楶杮爠捥牯獤戠⁥敲楶睥摥猠桴瑡䤠洠祡戠⁥灡牰癯摥琠牤癩 LICENSE NUMBER:__________________ DMV LICENSE CHECK___/___/___

*Must provide a current DMV printout (Current within 30 days)

Must provide current CA Driver’s License copy

*Must provide current automotive insurance policy

EXPIRATION DATE: ____/____/_____ *only required for new volunteer application

CLASS OF LICENSE: ____________

PERSONAL VEHICLE ID (Make, Model, Color) |LICENSE PLATE NUMBER | |

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I request that my driving records be reviewed so that I may be approved to drive department and/or my personal vehicle.

I agree to always operate in accordance with the California Vehicle Code and department policy

______________________________________________ ________________________

VFF Signature Date

I recommend approval to operate the following Department vehicles.

|Vehicle Type (circle) |Date of Drive Test |Date of Skills Test |Proctor |

|Utility | | | |

|Squad | | | |

|Rescue | | | |

|Water Tender | | | |

|Breathing Support | | | |

|Engine | | | |

|Other: | | | |

(Final test drive proctor must be a career captain or Battalion Chief)

*DATE OF LAST DEFENSIVE DRIVING CLASS:____/____/____

*DATE OF EMERGENCY VEHICLE OPERATIONS COURSE COMPLETION:____/____/____

*Only applicable if requesting to drive department vehicles

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