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  • Main Office: 455 Court Street, Binghamton, NY 13904

    Telephone: (607) 692-7669 ext. 205   Email: alexisVTS@rhnscny.org

  • Date of Birth*
     - -
  • Driver's License Expiration Date*
     - -
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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • What type of cell phone do you have?

  • Traffic Violations

  • Do you have any traffic violations?*

  • Convicted of Misdemeanor(s), Felony(s) or other crimes?

  • Have you been convicted?*
  • Date
     - -

  • Availability

  • What days of the week are you available?

  • Vehicle Information

    Vehicle must be a 2011 or newer
  • Insurance Expiration Date*
     - -
  • Vehicle Registration Expiration Date*
     - -

  • Background Check

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  • Background Check Authorization Form

  • ATTESTATION STATEMENT:

    Please read the following statement. I acknowledge I will be reimbursed for distance traveled from my home and back to my home while driving scheduled clients for the VTS. My automobile insurance will remain in effect; VTS’s insurance coverage is secondary. All requests for transportation will be screened and approved through the VTS. A Transportation Coordinator will contact you for specific dates and times.   If accepted, you agree to abide by VTS guidelines, including completion of required vouchers indicating client and the miles driven. Vouchers will be provided by the VTS. The vouchers should be completed at the end of each run.

    Please note the Volunteer Transportation Service does not discriminate. The eligibility of each driver is not based on age, race, color, or religious beliefs. Eligibility is based on the information provided by you as well as the references.

  • Date*
     - -
  • Should be Empty: