New Volunteer Application

Main Office: 24685 Route 37 Watertown, New York 13601
Telephone (315) 788-0422 Email info@volunteertransportation.org

What county do you reside in?

Choices: Jefferson, Lewis, St. Lawrence, Madison, Oswego, Erie, Genesee, Southern Tier

How did you learn about the VTC?

Full Name*

First NameLast Name

Date of Birth*

Date

SSN*

Driver's License Number*

Driver's License Expiration Date*

Date

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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Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Phone Number

Phone Number*

What type of cell phone do you have?

Android Smart PhoneApple Phone

Email Address*

example@example.com

Do you have any traffic violations?*

YesNo

Have you been convicted?*

YesNo

Date

MonthDayYear

Violation

Result

What days of the week are you available?

Insurance Company*

Insurance Expiration Date*

Date

Vehicle Registration Expiration Date*

Date

Vehicle Make*

Vehicle Model*

Vehicle Year*

Background Check Form (click to download)

Upload Signed Background Authorization

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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 VTC. My automobile insurance will remain in effect; VTC’s insurance coverage is secondary. All requests for transportation will be screened and approved through the VTC. A Transportation Coordinator will contact you for specific dates and times. If accepted, you agree to abide by VTC guidelines, including completion of required vouchers indicating client and the miles driven. Vouchers will be provided by the VTC. The vouchers should be completed at the end of each run.

Please note the Volunteer Transportation Center 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 inside the box)

Date

MonthDayYear

Traffic Violations

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

Availability

Vehicle Information

Background Check