VTS Volunteer Driver Application

Main Office: 455 Court Street, Binghamton, NY 13904

Telephone: (607) 692-7669 ext. 205 Email: alexisVTS@rhnscny.org
What county do you reside in?
How did you learn about VTS?
Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SSN
Driver's License Number
Driver's License Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Upload your valid driver's license

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Upload your vehicle registration

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Upload your vehicle insurance card

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Upload your NYS inspection sticker

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Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell phone number
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What type of cell phone do you have?
Email address
example@example.com
Traffic Violations
Do you have any traffic violations?
Convicted of Misdemeanor(s), Felony(s) or other crimes?
Have you been convicted?
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Violation
Result
Availability
What days of the week are you available?
Vehicle Information

Vehicle must be a 2011 or newer
Insurance Company
Insurance Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Vehicle Registration Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Vehicle Make
Vehicle Model
Vehicle Year
Background Check
Upload Signed Backgound Authorization

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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.
Signature (please sign in the box)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Traffic Violations

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

Availability

Vehicle Information

Background Check