LifeWise Vehicle Driver Screening

Initial Question

Will you be driving LifeWise Students?

Driver's License Type

Any driver who will be transporting LifeWise students more than once must apply as a LifeWise driver and complete the onboarding process.

This form should be used ONLY by drivers who will be borrowing a LifeWise vehicle, not by drivers who will be transporting LifeWise students. Any driver who will be transporting LifeWise students must apply as a LifeWise driver and complete a background check and necessary training.

Driver Information

First Name

Last Name

Date of Birth

LifeWise Program from which the Vehicle will be Borrowed

Name of Organization Borrowing LifeWise Vehicle

Driver's License State

Driver's License Number

Driver's License Expiration Date

Endorsement

PSOtherNoneSelect all that apply

CDL drivers are not permitted to drive students without a drug test on file with LifeWise.

Driver Screening Questions

Do you have an active LifeWise Background Check?

Have you been at fault for any accidents in the last 3 years?

Have you had any moving traffic violations in the last 3 years? ** If you have more than 1 major violation or more than 2 minor violations in the last 3 years, you will not be approved to borrow the LifeWise vehicle.

Have you had any moving traffic violations in the last 3 years?

Please explain the violations

Major moving traffic violations include, but are not limited to excessive speeding (more than 15 mph over limit), reckless operation, DUI/OWI/DWI, driving without a valid license, etc.)

Have you or any insurance company ever canceled or refused to provide insurance to you?

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

Do you have any physical impairments that will hamper your ability to drive students to and from LifeWise classes?

Have you ever been charged or convicted of "driving while intoxicated" or "driving under the influence"?

Due to answering YES to any of these question, your screening form will be reviewed. You will be notified if you are approved to borrow the vehicle.

Program ID