(LEVEL 1 DRIVERS ONLY)
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EMPLOYEE AND VOLUNTEER DRIVERS
PROCEDURES FOR COMPLETING THE DRIVER CERTIFICATION FORM
(Please retain for your records.)
1. The Driver Certification Form should be provided to employees and volunteers who wish to transport students in their personal or rental vehicles as allowed by Administrative Regulation 4114.4. Except in an emergency situation, no employee or volunteer should transport a student in his/her personal vehicle without a current, approved Driver Certification Form on file.
2. Drivers should complete the Driver Certification Form and attach the required documents (photocopies of license, registration and proof of motor vehicle insurance). Driver must sign and date the Driver Certification Form.
3. Driver should submit the completed Driver Certification Form and attachments to the school principal or the driver’s supervisor so that the principal/supervisor can verify that the vehicle’s seat belts are operational and that the child safety seats (if needed) are properly installed. Principal/supervisor must sign and date the Driver Certification Form.
4. The Driver Certification Form and all attachments must be sent to the Human Resources Department for approval. For faster processing, you may scan and email all documents to drivercertification@wsfcs.k12.nc.us.
5. HR will review all documentation to ensure it matches the Driver Certification Form. HR will run a motor vehicle records check on volunteer drivers. HR will not run the MVR on employee drivers unless there is reason to believe certification is not accurate. If an employee falsifies the Driver Certification Form he or she may be disciplined up to and including dismissal.
6. The HR Department will indicate on the bottom of the Driver Certification Form whether permission to transport students is granted or denied. A HR Director must sign and date the Driver Certification Form.
7. Once a decision has been made, the HR Department will return a copy of the Driver Certification Form with attachments to the email address provided by Driver. On that email, the HR Department will copy the principal of the school (or schools) indicated on the Driver Certification Form.
8. Once the Driver is approved, it is the principal’s or supervisor’s responsibility to ensure the proper parent permission is in place to transport the student. See AR 4114.4 for the types of permission required to transport students for field trips, extra-class activities, other transportation needs and emergencies.
9. HR will maintain the originals copies of the Driver Certification Forms.
10. Please allow five (5) business days to process and return the certifications.
11. Please note that certifications will expire on September 1 of each year. The heading of the Driver Certification Form will be updated annually to reflect the current school year so that it can be easily determined if an individual has a current approval on file. Annual recertification is required to ensure the driver still meets the requirements of the policy (still has a suitable vehicle with working seatbelts, license has not been revoked or expired, registration and insurance still current).
|DRIVER CERTIFICATION FORM (Exp. 9/1/19) |
|Required for Employees or Volunteers to Transport Students in a Personal or Rental Vehicle |
|Driver Name: |Mobile Phone: |Alt Phone: |
|Street Address: |School: |
|City: State: Zip: |Email Address: |
|I, the driver named above, understand and agree that I have been asked or assigned to transport students in my personal vehicle or a rental vehicle. In consideration |
|for WS/FCS providing secondary liability insurance for me, I certify and/or agree to the following terms and conditions: |
|To abide by the rules of the road and all other laws applicable to the safe operation of motor vehicles while driving of students. |
|All passengers shall wear seat belts at all times while the vehicle is moving. |
|At least two students should ride with one adult. However, if one student is transported, he/she shall ride in the back seat. |
|I shall not eat food or use a mobile device while driving students (no “speaker phone” or “hands-free” equipment). |
|My N.C. Driver's license is not currently suspended or revoked and that my license has not been suspended or revoked within the last five years. |
|I have not more than one conviction or Prayer for Judgment Continued (PJC) for a moving violation within the past twelve months. |
|I have no more than three convictions and/or PJCs for moving violations within the past seven years. |
|I have no conviction of Driving While Impaired (DWI) within the past seven years and not more than one DWI conviction or PJC ever. |
|I have no driver’s license suspension or revocation for moving violations within the past seven years. |
|I have no conviction of reckless driving conviction or PJC within the past seven years. |
|I have no conviction of or PJC for speeding in excess of 15 mph over the speed limit within the past seven years. |
|I have no conviction of or PJC for speeding to elude arrest ever. |
|I have no conviction of or PJC for passing a stopped school bus within the past seven years. |
|I have no more than two convictions and/or PJCs for chargeable accidents in the last seven years. |
|I understand and agree that WS/FCS reserves the right to conduct and may conduct periodic and/or random driving record checks with the NCDMV regarding my driving |
|record. |
|To grant permission for WS/FCS to obtain information from the NCDMV about my driving record. |
|To submit to random alcohol and drug tests, if requested by WS/FCS. |
|To report to the school principal or my supervisor all accidents (whether or not occurring while driving students) and any suspensions of my driver’s license or change|
|in auto insurance that occurs after this date. |
|To maintain auto liability insurance in an amount of not less than $30,000 per person, $60,000 per incident in respect of liability or injury or death of any students |
|who are passengers in any vehicle, and $25,000 in property damage. |
|That in case of an insurance claim, my automobile liability insurance applies before the WS/FCS insurance. |
|That excess automobile liability insurance protection is provided under the WS/FCS comprehensive general liability insurance policy for authorized drivers transporting|
|students in privately-owned vehicles on an approved school activity or function. This insurance is only for an amount in excess of the limit of liability provided by |
|the vehicle owner's automobile liability insurance policy. |
|Damage to the owner's vehicle is not insured by WS/FCS. |
|Driver: Attach to Certification driver’s license, automobile registration and proof of auto insurance, and sign below. |
|Driver’s Signature: |Date: |
|Principal/Supervisor: Verify seatbelts are operational and child safety seats properly installed (if needed) and sign below. |
|Principal/Supervisor Signature: |Date: |
|Permission to drive a vehicle transporting students has been granted denied. |Date: |
|Signature: |Title: Human Resources Director |
REV 7/25/2018
P:\Law3\Forms\Departmental Forms\HR-FORMS\Driver Certification Form 2018-2019.doc
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