NSBC Driver Screening

All drivers must complete a background check prior to driving. Drivers must be a member of NSBC for a minimum of 6 months. NSBC utilizes VerifiedFirst to verify driver information through the Alabama Department of Motor Vehicles. Applicants will receive an email from VerifiedFirst related to the completion of the background check and driver application. Please complete this form in its entirety and attach a valid photocopy of the front and back of your Driver’s License. Please print clearly.

Today’s Date

MonthDayYear

Driver’s Name (as shown on Driver’s License)

Valid Email Address

Telephone Number

Format: (000) 000-0000.

Home

Date of Birth

MonthDayYear

Alabama Driver’s License #

1.Have you been at fault for any accidents?

YESNO

Have you had any moving traffic violations?

YESNO

Have you had any insurance company cancel or refuse to provide you with auto insurance?

YESNO

Have you had your driver’s license revoked, suspended or restricted?

YESNO

Have you had any physical impairments other than corrective lenses?

YESNO

Have you been charged with or convicted of “driving while intoxicated” or “driving under the influence”?

YESNO

Answering YES to any of the above statements MAY disqualify you from being eligible to drive for NSBC. Please provide full details below or on an additional sheet. Please include dates, descriptions, amounts, or other explanation. The Business Administrator will review your information along with your Motor Vehicle Record and notify you concerning your qualification to drive NSBC vehicles.

I have read and understand the North Shelby Baptist Church vehicle usage policy. If I am approved as an NSBC Driver, I agree to abide by all policies and procedures established by the administration of the church.

Signed

Date

MonthDayYear

Copy of Valid Drivers License attached? Yes No

Once you've completed the form, please select "Submit." You're more than welcomed to "Preview PDF" and download or print for your records. You will receive a confirmation email from our office. If you do not receive the email, please feel free to contact us at your convenience.

DRIVER SCREENING APPLICATION