Driver Application

Driving Record: If you have had an accident or moving violation citation in the last 3 years, you must submit a copy of your Motor Vehicle Record (available at any MVD office) with this application. If you have a DUI or school zone violation, you are ineligible to drive an NMvanpools van for at least 5 years after the conviction. If any charges are pending, you may not operate a van until they are adjudicated.

ATTENTION: After you confirm and submit, please print, sign, scan, and send to info@nmvanpools.org.

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AUTHORIZATION TO OBTAIN MOTOR VEHICLE REPORT
I hereby authorize NMvanpools and/or HUB International Southwest, or one of its subsidiaries, on behalf of Zurich to obtain information from various consumer reporting agencies regarding my driving record. I understand that such information may be required now and from time to time in the future to comply with the safety program of this company and/or requirements of companies providing insurance to this company. I also understand that an acceptable record is contingent to being added to the company’s insurance for employment or continuation of my employment. I further understand that under the Fair Credit Reporting Act, my prospective or current employer must inform me of any adverse employment decisions based upon information obtained from my driving record and must provide me with a copy of the record that led to the adverse decision.

As a NMvanpools Driver, I recognize that I must: have a valid driver’s license; be medically fit at all times to operate a NMvanpools vehicle; comply with all requirements set forth by the Public Regulatory Commission for drivers of non-profit commuter vanpools; comply with NMvanpools ByLaws and Policies and Procedures and maintenance requirements; and, comply with state, local, and federal driving laws. By my agreement, I affirm that I have no medical condition which could impair my ability to safely drive a NMvanpools van and that I am not taking medication (prescription or nonprescription) which could impair my driving ability. I agree to report any accident, bodily injury, or property damage involving the vanpool vehicle promptly to the NMvanpools office and obtain copies of any and all reports regarding any damage to the NMvanpools vehicle or bodily injury to a member of NMvanpools. Further, by my signature below, I authorize NMvanpools to have my driving record checked at any time during the period I am a NMvanpools driver. I agree to immediately notify the NMvanpools office if given any moving violation citation of any kind whether received in a NMvanpools van or in my personal vehicle. I know that I am not authorized to drive any NMvanpools van until my Van Coordinator has been notified in writing of my approval and inclusion on NMvanpools insurance policy.
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If you encounter any issues with this form, please send an email to support@nmvanpools.org.