Volunteer Driver Application

Volunteer Driver Application
We need you as a volunteer driver! The difference you make in a neighbor's life will also be of great benefit to you. You can either download our PDF, print and mail it off, or complete the form below. Thank you for being the difference.
This online application should take 15-20 minutes to complete. There are five pages. Please have names and phone numbers of references, your driver's license and personal vehicle insurance card handy. If you are unsure of what will be asked, please download the PDF here.
What is Your Full Name?*
First Middle Last
Please Provide Your Home Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone
Home Phone*
Work Phone
Assigned Sex*
Date of Birth*
Date Format: MM slash DD slash YYYY
Email*

Driving Information
You are volunteering for a position that requires driving. New Rochelle Cares - Aging in Place requires a valid driver's license and proof of automobile insurance.
Are you able to use your automobile for this volunteer position?*
As a volunteer, I agree to provide a valid driver's license number and proof of automobile insurance. I agree to mail or deliver copies of these documents to New Rochelle Cares - Aging in Place so that they can be filed with this application. I will immediately notify my volunteer supervisor if my driver's license is restricted, suspended, revoked or expired.
Consent*
Yes I agree
Name of Insurance Carrier*
Insurance Policy Number*
Insurance Policy Expiration Date*
Date Format: MM slash DD slash YYYY
Driver's License Number*
Driver's License State of Issue*
Driver's License Expiration Date*
Date Format: MM slash DD slash YYYY
Auto Registration State of Issue*
Auto Registration Expiration Date*
Date Format: MM slash DD slash YYYY
Vehicle Information
My primary automobile is:*
Year*
Make*
Model*
Plate #*
Number of Seats*
Vehicle Information - Secondary Automobile (if applicable)
My secondary automobile is:
Year
Make
Model
Plate #
Number of Seats

Background Checks
Volunteer Driver positions require a criminal history background check and a motor vehicle background check. After receiving information about your consumer reporting rights, you, as the Applicant, will receive an email invitation from New Rochelle Cares - Aging in Place with a link to www.Intellicorp.net where you will be able to submit personal information (Social Security Number, driver's license number, address) directly and where you will be able to authorize Intellicorp to run the background checks at New Rochelle Cares - Aging in Place's expense.
You agree to respond to the Intellicorp invitation to run your background checks?*
Yes I agree
Signature*
New Rochelle Cares - Aging in Place acknowledges that equal opportunity for all persons is a fundamental human value. Each volunteer applicant will be considered on the basis of individual ability and merit, without regard to race, color, age, religion, national origin, disability, sexual orientation, sex or martial status.

Days of the Week When You're Able to Volunteer