LifeWise Vehicle Driver Application

Today's Date

Primary LifeWise Program

Are you interested in driving for other local LifeWise programs?

Are you or have you ever been a LifeWise employee?

Personal Info

First Name

Last Name

Email

Phone

Street Address

City

State

Zip Code

Birthdate

Are you a United States citizen?

YesNo

Are you eligible for hire in the United States?

YesNo

Have you carefully read the LifeWise Statement of Faith and are you in alignment with what we believe and what we teach?

YesNo

Driver's License Information

Driver's License State

Driver's License Expiration Date

Driver's License Number

Driver's License Type

Class

Endorsement

Please answer the questions below regarding your driving in the past ten years:

Have you been at fault for any accidents?

Have you had any moving traffic violations?

Have you had any insurance company cancel or refuse to provide you with auto insurance?

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"?

If you answered yes to any of the above questions, please provide full details below:

Please note if in the future you should receive any of the above citations, violations, suspensions, etc, you must notify LifeWise and your program director immediately.

Reference

Name

Phone

Email

Relation

What is this person's relationship to you? Family members should not be used as a reference.

Background Screening Acknowledgement

LifeWise Academy has a duty to undertake reasonable efforts to safeguard the children it serves, the public and its own interests. Therefore, it is the policy of LifeWise Academy, as a minimum requirement for consideration for service, to conduct a thorough background screening for all LifeWise Staff, Leadership Board and Volunteer Team members.

I understand that a criminal background check will be conducted on me as part of the application process and I consent to any such check.

Yes, I consent to a background check

Consent Statement

I understand and agree that any misrepresentation by me in this application will be grounds for immediate termination if I have been employed. I give LifeWise Inc. the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability LifeWise and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information. I also understand that I may be required to have a physical examination, including a drug screen.

Should employment result from this, I understand that I will be required to provide documentation to establish identity and employment eligibility. I understand that just as I am free to resign at any time, LifeWise reserves the right to terminate my employment at any time, with or without cause, and without prior notice. I understand that no representative of LifeWise has the authority to make any assurances to the contrary. Furthermore, I agree to abide by the guidelines and requirements of LifeWise and to refrain from any immoral conduct in the performance of my services of behalf of LifeWise.

I understand that this application does not constitute an offer of employment and that it does not create, nor is it intended to create, a contract of employment.

By checking this box and electronically adding my signature, I understand and affirm that my electronic signature is evidence of, and as legally binding as, my hand written signature. I certify that I have sole control of this application account and that it is my intent that this electronic submission is authenticated as my personal signature.

I agree with the statement above

YesNo

Today's Date

Full Name

Signature

Do you accept this signature as your own?

Yes