Staff & Volunteer Driver Application

Staff & Volunteer Driver Application
Date

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email
example@example.com
Previous experience of volunteering or transporting people with disabilities
Previous experience of supporting people with dementia
Emergency contact details
Name*

First NameLast Name
Phone Number*
Relationship to applicant
We need to check your Driving licence, tax and insurance which means we need your Driving licence number, and your car registration. We will also need a check code from the DVLA.

To get that copy and paste this web address, or click on it:-

https://www.gov.uk/view-driving-licence

By submitting this information you agree to us performing the necessary checks. We may have to carry out a DBS.

You also agree to abide by the guidelines when driving for Dementia Active, when transporting our members, and informing your insurance company that you are wishing to volunteer drive. (All details are on our website, click here).

We will check all these details again aunually.
Please upload your insurance certificate and driving licence here

Cancelof
Driving licence number*
Check code from DVLA*
Car registration number*
Signature

Clear
Should be Empty: