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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