Driver Partner Application

Name:*

First

Last

Address:*

Street AddressCityState / Province / RegionPostal / Zip Code

Phone:*

Area Code

-

Phone Number

E-mail:*

Mailing Address:

Street AddressCityState / Province / RegionPostal / Zip Code

Alt Phone:

Area Code

-

Phone Number

Drivers License:*

State:*

Expiration Date:*

Date of Birth:*

Social Security Number for I.D. Purposes Only:*

I authorize Yellow Cab of the Desert to run my motor vehicle driving record:*

Yes

No

Weight:

Hair Color:

Gender:

Male

Female

Height:

Age:

Leasing Program Desired

Subject to Availability:*

12 hours weekly AM

12 hours weekly PM

24/7 Weekly

50/50 Split (As Available ONLY)

Experience

Rate your knowledge of the Coachella Valley:*

Excellent

Good

Fair

Poor

Do you have any affiliation(s) with other area(s) of the transportation industry? (i.e., PUC license, Bus Driver, etc.):

Yes

No

If yes, explain:

Do you have experience driving in the taxicab industry:*

Yes

No

If yes, Years:

City/Region:

Please provide any additional information that qualifies you to be a professional taxicab driver:

References: (Must Provide Two References)

Name (Ref 1):*

First

Last

Phone (Ref 1):*

Area Code

-

Phone Number

Address (Ref 1):

Street AddressCityState / Province / RegionPostal / Zip Code

Name (Ref 2):*

First

Last

Phone (Ref 2:)*

Area Code

-

Phone Number

Address (Ref 2):

Street AddressCityState / Province / RegionPostal / Zip Code

Name (Ref 3):

First

Last

Phone (Ref 3):

Area Code

-

Phone Number

Address (Ref 3):

Street AddressCityState / Province / RegionPostal / Zip Code

Criminal Background

CRIMINAL BACKGROUND: List truthfully and completely any and all crimes you've been convicted of. Your fingerprints will be forwarded to the Department of Justice (DOJ) and a background check performed. In the event the DOJ reports convictions you have failed to indicate or disclose, any previously issued SRA permit will be revoked. If none, write "NONE."

Penal Code No.: #1

Name of Conviction: #1

Conviction Date: #1

City, State: #1

PC #: #2

Name of Conviction: #2

Conviction Date: #2

City, State: #2

Have you ever been required to register as a sex offender?*

Yes

No

Time periods you were required to register?

Driving Record

DRIVING RECORD: List all moving violations within three years prior to submission of this application. This should coincide with a current DMV information printout. If none, write "NONE."

Penal Code No. #1 (DR)

Name of Conviction: #1 (DR)

Conviction Date: #1 (DR)

City, State: #1(DR)

PC No. #2 (DR)

Name of Conviction: #2 (DR)

Conviction Date: #2 (DR)

City, State: #2 (DR)

Taxi Permit

Do you have a current SRA Taxi Driver's Permit?

Yes

No

Prior Permit Number:

Expiration Date:

MEMORANDUM OF UNDERSTANDING PLEASE READ CAREFULLY BEFORE SIGNING

Any false, incomplete or inaccurate statement herein will result in the denial of the Taxi Driver's Permit, and will result in the revocation of any permits previously granted.

THE UNDERSIGNED APPLICANT UNDERSTANDS:

prior to issuance/renewal, applicant must submit to and pass a controlled substance and/or alcohol test;
all drivers holding a valid SRA, Taxi Driver Permit shall be subject to random testing for controlled substance and/or alcohol and failure to submit to a noticed random will result in the immediate revocation of any previously issued permit;
all drivers holding a valid SRA Taxi Driver Permit are immediately subject to reasonable suspicion testing for controlled substances and/or alcohol.
SRA Taxi Driver Permits are valid for indicated Taxi Operator only and become null and void upon termination of lease or expiration.

The undersigned applicant hereby authorizes SRA, or its agents or employees, to seek information and conduct an investigation into the truth of the statements set forth in this application and the qualifications of the applicant.

Signature: (Please type out full name)*

Date:*

Verification: