Safe Church - Volunteer Driver Information Form • Menai Baptist Church

Please complete the following form if you drive a vehicle as part of your paid or volunteer service to the church.

First Name *

Middle Name *

Last Name *

Date of Birth *

Driver's Licence Number: *

State of Issue: *

Expiry Date: *

Type of Licence: *

Is your vehicle/s registered? *

Yes

No

If 'YES' - please list your registration number/s:

If 'NO' - you cannot drive as a volunteer in the vehicle/s listed.

Do you have any restrictions on your driver's licence? (i.e. P Plater) *

No

Yes

If 'YES' explain here:

Have you been involved in any motor vehicle accidents while driving during the past 5 years? *

No

Yes

If 'YES' explain here:

Have you been convicted of any traffic offences (other than parking) during the past 5 years? *

No

Yes

If 'YES' explain each separate conviction here.

Each of my responses is truthful and accurate. I agree to notify the church within a reasonable time of any changes in the above information.

Signature:

Date: *

Volunteer Driver Information Form

Completed and Approved

Uncompleted

MBC - VOLUNTEER DRIVER INFORMATION FORM