Transport Form

Staff Transport Form
Bridges Office Location *
Staff Name *

First Name Last Name
Transporting Option *
By signing below and selecting the Non-Transport option i am verifying and agreeing to the following:
- I have reliable transportation to and from work.
- I have a valid driver's License
- I will not transport any clients, at any time, for any reason.
- I will call 911 if an emergency should occur and transportation is necessary.
- I understand that if I violate this agreement.
  - I will be violating State Regulations.
  - This will be grounds for termination of my employment.
By signing below and selecting the Transport option i am verifying and agreeing to the following:
- I have reliable transportation to and from work.
- I have a valid drivers license.
- I have current auto insurance.
- I understand that if I lose my license or insurance for any reason I must immediately notify my supevisor.
- Failure to have a valid license is grounds for immediate termination of my employment.
Attach Photo of Auto insurance (Employee's Name must be clearly listed) *
Date *

- Month - Day Year
Date
Employee Signature *
Should be Empty: