We sincerely appreciate your interest in volunteering providing this worthy community service.

Transcription

1 We sincerely appreciate your interest in volunteering providing this worthy community service. Can you imagine how it feels to need to go to the doctor for a life-saving treatment but not have a way to get there? What if you wanted to visit with friends but you were the only one who couldn t make it because you didn t have a ride? Many older adults live with this loss of independence every day. Without transportation simple things such as medical appointments, grocery shopping, or a hair salon appointment become major challenges. You can be a part of ITNCharlestonTrident s dignified transportation solution by joining our program. Help older adults stay connected to our community and ease their feelings of isolation and loneliness by driving them to appointments, personal outings, and other daily activities. Flexible hours you choose who, when, and where you drive Convenient, and web-based scheduling system Participate in a well-respected community based non-profit and United Way affiliated organization. We average rides/month so it's fairly easy to find a ride that fits your schedule. Much of the driver scheduling is done via after you view an online ride list. All this is explained further in the orientation. We make it very easy to choose rides that fit your schedule. Volunteer Driver Application This document is a Volunteer Driver application, background and driving record request forms. Please complete all three forms and return to our office via mail. We must have the signed originals. 1. On the SC DMV Form, Part 2 - print your name, driver's license number and date of birth. In the Consent Section - print your name, sign and date. A photocopy of your drivers license is helpful. 2. On the Background Records Form - Fill in your information (print clearly) sign and date it. Be sure to print your Full Legal Name. After the record checks are completed you will be contacted to arrange a short orientation. The orientation normally takes about 1.5 hrs and can be done at our office in North Charleston on Rivers. Ave. or we can arrange to meet you elsewhere. Again, thank you for your interest. We look forward to hearing from you soon. If you have any questions please call or us Eagle Drive, Bldg. 100, North Charleston, SC Phone: Ken.Harrell@ ITNCharlestonTrident.org Web:

2 Volunteer Driver Position Description Main Duty: Drive ITN customers (seniors 65 and older, and people with visual impairments) wherever they want to go within the service area. Medical appointments, shopping, and to visit friends are frequent ride requests. Time Frame: Length of Commitment: Schedule: One year, three hours/month (more if possible). Flexible. We will accommodate you. Qualifications Sought: 1. Valid driver s license and three years driving experience. 2. Acceptable record of safe driving (no moving violations for three years) and clean criminal history check. 3. Proof of liability insurance for vehicle. 4. Current registration and inspection sticker on vehicle, if applicable. 5. Personal references from three non-relatives. 6. Ability to lift wheelchairs and walkers, and carry packages up to 25 lbs. Benefits: 1. Make a difference in someone s life. 2. See the face and hear the voice of the person you are helping. 3. Meet other community-minded people. 4. Learn community history from the people who lived it. 5. Receive training. 6. Build your resume. 7. Receive mileage reimbursement. 8. Earn ITN transportation credit for unoccupied miles for yourself or someone special to you. 9. Receive discounts from area merchants for ITN volunteers. 10. Receive a free membership for someone you care about. 11. Invitations to ITN volunteer appreciation events. Responsibilities: 1. Maintain an insured, registered, and inspected vehicle and inform the ITN office in writing of any changes to your motor vehicle record or insurance policy (i.e. accidents and moving violations). 2. Provide safe, clean, comfortable transportation. 3. Be on time. 4. Report your mileage. 5. No smoking during the entire shift. 6. Do not consume alcohol or take prescription drugs that will affect your ability to drive before your shift.

3 7. Wear your ID tag and have the ITN placard visible in your car s side window. 8. Maintain a professional relationship with the ITN customer. It is inappropriate to request favors or accept gifts or tips from customers. Customers may make a donation in your name to ITN if they wish to thank you. 9. Call the dispatch office with any changes (i.e. running late, making an unscheduled stop, inability to do a scheduled ride). 10. Maintain confidentiality. Please do not share personal information. Professional behavior is absolutely necessary. 11. Maintain good communication with the dispatcher about everything! For Further information Contact: Ken Harrell, Ride Operations Manager Phone: (843) Fax: (843) ken.harrell@itncharlestontrident.org

4 6296 Rivers Avenue, Suite 303 North Charleston, SC (843) (843) (fax) Volunteer Driver Application Name Telephone(H): (W): Address (Cell phone): (Fax): ( ): Driving Please list the days of the week, and hours of the day, you would like to commit to drive for the ITN. (See chart on last page for schedule breakdown.) Years of driving experience Estimated miles driven last year When was the last time your vision was examined? Is your vision adequate for driving? Please list any limitations Employment Current Employment: None Full-time Part-time Between jobs Retired Occupations Organizations to which you belong Education Highest grade/degree completed First Aid training, if any Legal Have you had any past criminal convictions, or do you have any charges pending against you in a court of law? Have you been convicted of any moving violations in the past three (3) years?

5 References Please list the names and telephone numbes (or mailing address) of three persons not related to you, whom you have known for at least one year. #1 Name Phone (or mailing address) How acquainted? #years known #2 Name Phone (or mailing address) How acquainted? #years known #3 Name Phone (or mailing address) How acquainted? #years known Emergency Contact Name Relationship Street Address City State Zip PhoneContact(s) (H) (W) (cell) This information given in this application is correct to the best of my knowledge. I give the Independent Transportation Network permission to check on this information, and to contact references. Signature Date Thank you for your interest in volunteering for ITNCharlestonTrident How did you learn about the ITN? What specifically led you to volunteer for the ITN? What, if any, volunteer work have you done before? The following information will be helpful for us with future volunteer recruitment. Please rank your reasons for wanting to drive for the ITN,with 1 the most important reason, and 6 being the least. Serve the community Enjoy driving Help elderly people Additional income Something to do Enjoy elderly people For Office Use Only Inquiry Application Application Checks First Second Third Screening Checks Driving Sent Received Sent Call Call Call Received

6 Volunteer Provided Vehicle Description Information Your name: Vehicle owner's name (if you are not the owner): Street address, town, and phone number of vehicle owner (if you are not the owner): 1 St Vehicle Description: (if more than one vehicle will be used for transporting ITN customers, please fill in the 2 nd Vehicle Description below) Make: Model: Type Year: Plate #: Color: Number of doors: Registration expiration date: Insurance company: Policy # Expiration Date: Limits of Liability: $ (we suggest carrying $100k bodily injury, $300k multiple persons $100k property damage) Local Agent: Address: Phone: Important Note: Please provide a copy of your Auto Insurance Declaration page. Please describe the general condition of the vehicle and any known defects: Please check one of the following: This is the only vehicle I will be using for the ITN. I will be using more than one vehicle for the ITN. Your Signature: Date:

7 Volunteer Provided Vehicle Description Information 2 nd Vehicle Description Information Vehicle owner's name (if you are not the owner): Street address, town, and phone number of vehicle owner (if you are not the owner): Vehicle Description: Make: Model: Type Year: Plate #: Color: Number of doors: Registration expiration date: Insurance company: Policy # Expiration Date: Limits of Liability: $ Agency: Address: Phone: Important Note: Please provide a copy of your Auto Insurance Declaration page. Please describe the general condition of the vehicle and any known defects:

8 Volunteer Driver Informed Consent ITNCharlestonTrident is a non-profit corporation with a mission to provide community based, consumer oriented transportation for seniors age 65 or older who choose not to drive, and for people with visual impairments. The research and development of the Independent Transportation Network (ITN) is possible through support from the American Association of Retired Persons, the Transportation Research Board, the Federal Transit Administration, the National Highway Traffic Safety Administration, the UNUM Foundation, and other organizations. Each of these organizations has an interest in the development of an economically selfsustaining transportation service that helps seniors meet their mobility needs with dignity and independence. Your participation as a volunteer driver is an important part of the development of this service. The questions we ask you on this volunteer driver application help us to understand the reasons why you and others choose to volunteer to drive, and the history of your volunteer effort helps us develop a record of community participation in the ITN. Your participation is entirely voluntary and the information you provide is confidential. Your signature indicates: 1) You understand that you will be participating in a project that uses the information collected from your volunteer effort for research to develop the ITN and to better understand transportation for seniors: and 2) You agree to maintain the confidentiality of customers and their families. VOLUNTEER DRIVER Signature Date ITNCharlestonTrident Signature Date

9 South Carolina Department of Motor Vehicles Request for Driver Information MV-70 (Rev. 1/08) PART 1 Part 1 must be completed before information listed on Parts 2 (singl e request) or 3 (multiple requests) will be released. Check the boxes of permissible uses that apply to you under Federal Law (18 USC, Chapter 123). Persons submitting this form to obtain someone else's record should read the Federal law before signing. See Part 3 of this form for how to find a copy of the law. Under Federal Law, driver personal information may be obtained only for certain uses. The following is a short version of permissible uses: 1. For use by any government agency in carrying out its functions. 2. For a business to verify the accuracy of personal information previously provided to the business. 3. To use in any court proceeding, or investigation in anticipation of litigation. 4. For research and statistical purposes so long as the personal information is not published, redisclosed, or used to contact individuals. (Such requests are processed only in Blythewood DMV Headquarters. See special instructions on back of this form.) 5. For use by an insurer for claims investigations, rating and underwriting. 6. For use by an employer or their insurer to verify commercial driver license information. 7. For any other use by the driver or by wr itten consent of the driver. (See "Consent" in Part 2.) Under penalty of perjury, I state that I am entitled to receive and use this information as permitted under the Driver's Privacy Protection Act of 1994 (18 USC, Chapter 123 as amended). I further acknowledge that if I misuse this information or give it to someone who uses it for an unauthorized purpose, I may be subject to Federal criminal law as well as a civil lawsuit where the minimum award is $5, Print Name of Person/Business Requesting Information Date Address of Person/Business Requesting Information Print Name of Person Receiving Information PART 2 - To be used to obtain information on a single driver. Signature of Person Receiving Information Name DL/BP/ID # (if available) Date of Birth Information Requested: 10 Year Driving Record CONSENT: (only needed if Box 7 of Part 1 is checked) I,, give consent for the release of my personal information to Print name of Driver the person shown above. Signature of Driver REQUIRED FEES FOR EACH SEPARATE DOCUMENT: MAIL TO: Copy of MVR $ 6.00 Alternative Media Copy of Ticket/Suspension Notices $ 6.00 P.O. Box 1498 Other related documents $ 6.00 Blythewood, SC Make check or money order payable to: S C Department of Motor Vehicl es. (NO CASH ACCEPTED) OFFICE USE ONLY Date Identification presented by person receiving information Office Code Employee Processing Request Date

10 NOTICE AND ACKNOWLEDGMENT [IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT] NOTICE REGARDING BACKGROUND INVESTIGATION may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject of a consumer report and/or an investigative consumer report which may include information about your character, general reputation, personal characteristics, driving record, and/or mode of living, and which can involve personal interviews with sources such as your current and past employers, friends, or associates, as well as past employment information in compliance with regulations of the U. S. Department of Transportation (DOT), including 49 CFR Part 40 and 49 CFR Part 382, regarding DOT drug and alcohol testing results from past employers. These reports may be obtained at any time after receipt of your authorization and, if you are hired, throughout your employment. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by PreHire Screening Services LLC, 1201 Sovereign Row, Oklahoma City, OK 73108, 1-(866) The scope of this notice and authorization is all-encompassing, however, allowing to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and, if you are hired, throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report. ACKNOWLEDGMENT AND AUTHORIZATION I acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of consumer reports and/or investigative consumer reports at any time after receipt of this authorization and, if I am hired, throughout my employment. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by PreHire, or another outside organization acting on behalf of and/or itself. I agree that a facsimile ( fax ) or photographic copy of this Authorization shall be as valid as the original. New York applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by the Employer by contacting PreHire Screening Services LLC directly. Oklahoma applicants or employees only: I request a copy of any credit report requested on me. (Check box) Minnesota applicants or employees only: I request a copy of any consumer report requested on me. (Check box) California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report if one is obtained by the Company at no charge whenever you have a right to receive such a copy under California law. Under Section (a)(2)(B)(vi) of the CA Civil Code, you are notified that PreHire Screening Services LLC privacy practices can be found at Under Section of the CA Civil Code and Section of the CA Labor Code, you are notified that a credit report may be ordered if you are applying for a position involving access to confidential or proprietary information. Use of date of birth is for identification purposes only to conduct the background check. The Company is an equal opportunity employer. Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status. LEGAL NAME OF AUTHORIZING CONSUMER: ANY OTHER NAMES I HAVE BEEN KNOWN BY (INCLUDING MAIDEN NAME): SOCIAL SECURITY NUMBER: DATE OF BIRTH: DRIVER'S LICENSE NUMBER AND STATE ISSUED: CURRENT ADDRESS: PREVIOUS ADDRESSES (LAST 7 YEARS): SIGNATURE OF AUTHORIZING CONSUMER: DATE:

11 Para información en español, visite o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment or to take another adverse action against you must tell you, and must give you the name, address, and phone number of the agency that provided the information. You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your file disclosure ). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: a person has taken adverse action against you because of information in your credit report; you are the victim of identify theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See for additional information. You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See for an explanation of dispute procedures. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed

12 or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate. Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to You may limit prescreened offers of credit and insurance you get based on information in your credit report. Unsolicited prescreened offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. Identity theft victims and active duty military personnel have additional rights. For more information, visit

13 States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact: TYPE OF BUSINESS: 1.a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates. b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the CFPB: 2. To the extent not included in item 1 above: a. National banks, federal savings associations, and federal branches and federal agencies of foreign banks CONTACT: a. Consumer Financial Protection Bureau 1700 G Street NW Washington, DC b. Federal Trade Commission: Consumer Response Center FCRA Washington, DC (877) a. Office of the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street, Suite 3450 Houston, TX b. State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and Insured State Branches of Foreign Banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations d. Federal Credit Unions b. Federal Reserve Consumer Help Center P.O. Box 1200 Minneapolis, MN c. FDIC Consumer Response Center 1100 Walnut Street, Box #11 Kansas City, MO d. National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street Alexandria, VA Air carriers Asst. General Counsel for Aviation Enforcement & Proceedings Aviation Consumer Protection Division Department of Transportation 1200 New Jersey Avenue, SE Washington, DC Creditors Subject to Surface Transportation Board Office of Proceedings, Surface Transportation Board Department of Transportation 395 E Street S.W. Washington, DC Creditors Subject to Packers and Stockyards Act, 1921 Nearest Packers and Stockyards Administration area supervisor 6. Small Business Investment Companies Associate Deputy Administrator for Capital Access United States Small Business Administration 409 Third Street, SW, 8th Floor Washington, DC Brokers and Dealers Securities and Exchange Commission 100 F St NE Washington, DC Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations 9. Retailers, Finance Companies, and All Other Creditors Not Listed Above Farm Credit Administration 1501 Farm Credit Drive McLean, VA FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center FCRA Washington, DC (877)