1/15/2020 Cougar Safe Rides Volunteer Application https://docs.google.com/forms/d/1Wr8MXKusE9OtRiBVf0ORt0QjxSBplH_KKCWystkZuMo/edit 1/4 Cougar Safe Rides Volunteer Application If you have any questions about filling out this form, please feel free to email us and we will set up a time to meet and walk you through the process. Please note, there are two additional forms attached to this application. The forms are WATCH and MVR. Please fill them out, sign them, attach a copy of your ID and turn them in with your application. The WATCH and MVR forms will be sent to Human Resources, who will make sure you are cleared to volunteer with us. This process will take a few days, so be sure to turn them in as soon as possible! In addition to filling out these forms, you are also required to attend a training session. After successful completion of the training, you will receive volunteer credit for your time. To learn more about upcoming training sessions, please check your email, web page, or social media. You can also contact our office or the Women’s Center! This semester, Cougar Safe Rides is expected to operate Thursday from 8 p.m.- 12 a.m., Friday- Saturday from 8 p.m. to 2 a.m. Please note, Cougar Safe Rides does not operate during student and university holidays, or when weather conditions prevent safe driving. The signature at the bottom of this application can not be electronically signed it must be hand signed with an ink pen. After completing this application please drop it off at our office located in the Women's Center in Wilson Short Hall Room 8A, if no one is in the office you may drop it off in our mailbox located outside of our office next to our door. For more information about Cougar Safe Rides, please contact the Operations Program Supervisors at our email [email protected]. Thank you! 1. Today's Date: Example: December 15, 2012 2. Full Name (First Last): 3. Date of Birth: Example: December 15, 2012 4. Address: 5. WSU Email:
Cougar Safe Rides Volunteer ApplicationIf you have any questions about filling out this form, please feel free to email us and we will set up a time to meet and walk you through the process.
Please note, there are two additional forms attached to this application. The forms are WATCH and MVR. Please fill them out, sign them, attach a copy of your ID and turn them in with your application. The WATCH and MVR forms will be sent to Human Resources, who will make sure you are cleared to volunteer with us. This process will take a few days, so be sure to turn them in as soon as possible!
In addition to filling out these forms, you are also required to attend a training session. After successful completion of the training, you will receive volunteer credit for your time. To learn more about upcoming training sessions, please check your email, web page, or social media. You can also contact our office or the Women’s Center!This semester, Cougar Safe Rides is expected to operate Thursday from 8 p.m.- 12 a.m., Friday- Saturday from 8 p.m. to 2 a.m. Please note, Cougar Safe Rides does not operate during student and university holidays, or when weather conditions prevent safe driving.
The signature at the bottom of this application can not be electronically signed it must be hand signed with an ink pen. After completing this application please drop it off at our office located in the Women's Center in Wilson Short Hall Room 8A, if no one is in the office you may drop it off in our mailbox located outside of our office next to our door.
For more information about Cougar Safe Rides, please contact the Operations Program Supervisors at our email [email protected].
7. I am interested in being a: (Please select all that apply)Check all that apply.
Dispatcher
Co-Pilot
Driver
8. How did you first find out about Cougar Safe Rides?Mark only one oval.
Women's Center
The Daily Evergreen
Friend
Flyer
Alive! Orientation
Other:
9. How Confident are you...Mark only one oval per row.
VeryConfident Confident Somewhat
ConfidentNot
Confident
Navigating WSU's campus aswell as the streets,neighborhoods, and apartmentsin Pullman with GPS and a Co-PilotIn your ability to drive in winterweather conditions (snow, rain,ice, fog, etc.)
10. Please check the days and times you are willing to volunteer:Please note: This is not a commitment; you will sign up for specific shifts once you have completedtraining. You will not be restrained to the options you select in this application!Check all that apply.
11. What size of unisex shirt fits you best?Mark only one oval.
XS
S
M
L
XL
XXL
Other:
12. Cougar Safe Rides Volunteer AgreementI have read and understand the contents of this application. I have completed this form with accurateinformation and agree to submit to the conditions necessary in the application process. I understandand agree to abide by the program requirements and code of conduct. I understand that thisinformation will not be shared outside of the Women's Resource Center and Cougar Safe Rides staff.Mark only one oval.
I agree
I disagree
13. Criminal History CheckI authorize Cougar Safe Rides to request a background check. I understand that all volunteers will besubjected to a background check, and that a request for criminal history information will be submittedon my behalf to the Washington State Patrol Identification and Criminal History Section in order toensure the safety of those who use this service.Mark only one oval.
I agree
I disagree
14. Motor Vehicle Record CheckI understand that all Cougar Safe Rides drivers must have a Motor Vehicle Record check performedin order to verify their driving record, and I authorize Cougar Safe Rides to perform this check on mybehalf. I understand that if I am licensed in the state of Washington, I will need to submit an additionalrelease form to give WSU permission to perform this check.Mark only one oval.
I agree
I disagree
15. Assumption of RiskIn consideration for the opportunity to participate, I voluntarily agree to assume all risks involved inmy participation, including travel to and from a community project site. I understand that if I voluntarilyparticipate, I expose myself to risk of personal injury and/or death or loss including, but not limited torisks listed in the project description. I also recognize that there are both foreseeable andunforeseeable risks of injury or death that may occur that WSU cannot specifically anticipate and listhere. I understand that Washington State University provides no medical insurance for its studentsand it is my responsibility to provided health insurance coverage for myself while I am participating inthis activity.Mark only one oval.
16. Additional Risk Statement (Social Service/Seniors)I voluntarily agree to assume all risks involved in my participation in this project including, but notlimited to: risk of physical injury due to a variety of activities (bending, lifting, etc.); risks associatedwith access to vulnerable populations (seniors, individuals with disabilities), including potentialexposure to viruses, sensitive/confidential information, and interactions that may be emotionallychallenging.Mark only one oval.
I agree
I disagree
17. Release of LiabilityI release the state of Washington, the Regents of Washington State University, WSU, any subdivisionor unit of WSU, its officers, employees, and agents, from any and all liability, claims, costs, expenses,injuries and/or losses, that I may sustain as a result of my participation in the above project. Myparticipation includes, but is not limited to, travel to and from the project site in a private or publicvehicle, and any activity connected with the project itself, and while using state equipment or facilitiesfor the project whether on or off WSU property.Mark only one oval.
I agree
I disagree
18. Office of Student ConductWere you referred by the WSU Office of Student Conduct for a community service placement?Mark only one oval.
Yes
No
19. Acknowledgement StatementI have carefully read this document, understand its contents, and am fully informed about this eventand circumstances and am satisfied that I can safely participate in this event. I am over the age ofeighteen and am aware that this document is a contract with WSU.Mark only one oval.
Employers, prospective employers, volunteer organizations, or their agent can get driving records for an employee, prospective employee, or volunteer when authorized. Use this form to get their authorization.• Complete the Company section.• Give this form to your employee, prospective employee, or volunteer to complete their section.• For audit purposes, keep this completed form in your files for at least two years. Do not mail it to the Department of Licensing.
Sealed juvenile records. Information contained in a driving record related to a sealed juvenile record may not be used for any purpose unless required by federal law. The employee or prospective employee may furnish a copy of the court order sealing the juvenile record to the employer, prospective employer, or their agent.
Company – To be completed by the company or the agent of the companyPRINT or TYPE Company name
Agent company name (if applicable)
Company/Agent company address
Authorized representative name Title
Answer the following
1. Is this company an employer, prospective employer, or volunteer organization of the individual whose driving record is being requested? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
2. Is the record you are requesting necessary for employment purposes related to driving by the employee or prospective employee as a condtion of employment or related to driving by the volunteer at the direction of the volunteer organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
3. Do you agree to use the information contained in the record exclusively for this purpose and not divulge it to a third party?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
4. Do you agree to hold harmless the Washington State Department of Licensing for all matters relating to the release of the requested driving record?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Certification
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
Date and place signed Authorized representative signature
Employee, prospective employee, or volunteer – Complete this section and return the form to the companyPRINT or TYPE Full name (First, Middle, Last) of employee/prospective employee/volunteer Date of birth (mm/dd/yyyy) WA driver license number
Authorization from
Employee – for release of my driving record for employment purposes, at my employer’s discretion for the full term of my employment
Prospective employee – for release of my driving record for employment purposes, not to exceed 30 days from date signed
Volunteer – for release of my driving record for a position applied for that requires me driving at the direction of the volunteer organization
Employer, prospective employer, or volunteer organization name
Employer agent company name if acting on behalf of the company for employment purposes
Authorization
I am an employee, prospective employee, or volunteer of the company named above and I request that a copy of my Washington State driving record be sent to them/their agent.
