Volunteer Bus Driver Application

Applicant’s Full Name *

Date of Birth *

Address *

Email *

Phone *

Current NSW Licence

Yes

No

(Minimum LR - Licence will be sighted before engagement.)

Class of Licence *

Expiry Date *

Working With Children Check

Do you have a current WWCC? *

Yes

No

If Yes, please provide a photocopy or authorization number.

File Upload *

Maximum file size: 134.22MB

APP

OR

WWC

NSW Mobility Parking Scheme Declaration

Please read the document NSW Mobility Parking Scheme and complete the driver declaration here:

I have read the above Conditions of Use and parking concessions for the disability parking permit issued to:

Date

Signature

Clear

Name of driver

COVID-19 Vaccination Status

Have you received all required COVID-19 Vaccinations?

Yes

No

Attach copy of COVID-19 digital certificate.

Maximum file size: 134.22MB

Driving History

Have you ever been charged with or convicted of a motoring offence other than a parking offence in the last three years? *

Yes

No

Please list below or attach details *

File Upload

Maximum file size: 134.22MB

During the last three years have you been involved in a motor vehicle accident or claimed against an insurance company for motor vehicle damages? *

Yes

No

Please list or attach details *

File Upload

Maximum file size: 134.22MB

Insurance

Has any insurer refused or cancelled or required special terms to insure you for motor vehicle coverage ? *

Yes

No

Please list below or attach details *

File Upload

Maximum file size: 134.22MB

Health

Have you ever suffered from (or are now suffering from) defective vision, heart complaint, fits of any kind or any other disability that may affect your ability to drive? *

Yes

No

Please list below or attach details *

File Upload

Maximum file size: 134.22MB

Do you regularly take any medication that may have any effect on your ability to drive a motor vehicle? *

Yes

No

Please list or attach details *

File Upload

Maximum file size: 134.22MB

Are there any other relevant facts which may influence your ability to drive or our ability to insure you? *

Yes

No

Please provide details *

Referees

Please provide the contact details for 2 character referees.

Referee 1 *

Name and contact phone number

Referee 2 *

Name and contact phone number

Emergency Contact

Name *

Relationship *

Phone *

Social Media Consent

I consent to my image/voice and activity undertaken being used on CoastAbility website, print media and/or social media sites (Facebook, Instagram, YouTube, Twitter) on behalf of CoastAbility and for no other purpose. *

Yes

No

I agree to be contacted should CoastAbility be approached about any additional media use requests so that further consent may be given in respect thereto. *

Yes

No

Please confirm where multimedia can be used: *

IN PERPETUITY

ONCE ONLY

Embedded_Entry_ID

Tick for declaration *

I declare that the above information is true and correct to the best of my knowledge.

Your Full Name *

Date *

reCAPTCHA

NB: You will automatically be emailed a copy of the completed submission when you click Submit.

Bus Driver Application

Volunteer Bus Driver Application Form

NSW Mobility Parking Scheme PDF

Working With Children Check

NSW Mobility Parking Scheme Declaration

COVID-19 Vaccination Status

Driving History

Insurance

Health

Referees

Emergency Contact

Social Media Consent