Hope House Driver Authorization Form Hope House For Our Families Driver Authorization Form Section 1: Driver Information Full Legal Name * Date of Birth * Home Address * City, State, Zip * Mobile Phone Number * Email Address * Employee or Volunteer? * -- Select One -- Employee Volunteer Both Section 2: Driver's License Information Driver's License Number * State of Issue * License Expiration Date * Upload a Copy of Your Driver's License * How many years have you been licensed to drive? * Section 3: Driving Assignment Eligibility Which Hope House driving activities are you willing to assist with? (Check all that apply) Transporting Hope House participants/residents Transportation to treatment programs Transportation to recovery meetings Transportation to court appointments Transportation to medical appointments Transportation to employment interviews Transportation to employment sites Transportation for Hope House events Picking up donations Delivering supplies Picking up food donations Transportation of staff Airport transportation Emergency transportation needs Other: Are there any restrictions on when you are available to drive? Section 4: Emergency Contact Emergency Contact Name * Relationship * Phone Number * Alternate Phone Number (Optional) Section 5: Driver Agreement I agree to: Maintain a valid driver's license at all times. Immediately notify Hope House if my license becomes suspended, restricted, or revoked. Obey all traffic laws and regulations. Refrain from texting, emailing, or using a handheld device while operating a vehicle. Never operate a vehicle while impaired by alcohol, drugs, medication, or fatigue. Wear a seatbelt and require all passengers to do the same. Report all accidents, citations, incidents, or vehicle damage immediately. Operate Hope House vehicles responsibly and respectfully. Follow all Hope House transportation policies and procedures. Protect the privacy and dignity of Hope House participants and families. I have read and agree to the Driver Agreement. * Yes No Section 6: Electronic Signature By signing this form, I certify that the information provided is true and accurate and understand that authorization to drive for Hope House For Our Families may be revoked at any time. Typed Full Name (Electronic Signature) * Date Signed * Submit Authorization Form
