Driver Authorization This form must be completely filled out and submitted to the Facilities, once each fiscal year (July 1 to June 30) leaving at least five (5) business days for a decision. A "Pass" or "Fail" of the driver history check will be determined by using GCC's Driver History Criteria. Results of this driver history will be emailed to Ryan Aiken (Administrative Services), to the GCC email address of the applicant (if the email is supplied on this form) and to the GCC email address of the employee requesting that you drive (if it is someone other than the applicant). Contact Ryan Aiken (x1309) about the status of your request and other college vehicle questions. Contact Facilities Management if you have questions about items on this form or the review process/decision. Only this form is sent to Facilities. Van request/reservation forms go directly to Ryan Aiken. ***STUDENTS ARE NOT ELIGIBLE TO DRIVE COLLEGE VEHICLES UNLESS THEY ARE UNDER CONTRACT*** Applicant's legal name(Required) First Last Middle name Legal address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of birth(Required) MM slash DD slash YYYY Gender(Required) Male Female Date of first trip (if known) MM slash DD slash YYYY Current driver's license #(Required) State of issue (2 letter abbr.)(Required) Expiration date(Required) MM slash DD slash YYYY Have you been a licensed driver for at least 1 year (do not include learner's permit, etc.)?(Required) Yes No Have you had any at-fault accidents in the last 3 years?(Required) Yes No List the dates of at-fault accidents(Required) Have you been found responsible for a non-criminal moving violation (speeding, stop sign and red light violations, etc.) in the last three (3) years?(Required) Yes No List all incidents where you were found responsible for the above (include state, approx. date of offense, and specific offense).(Required)Have you been found guilty of or admitted sufficient facts for a non-criminal moving violation (speeding, stop sign and red light violations, etc.)?(Required) Yes No List all incidents where you were found guilty of or admitted sufficient facts for the above (include state, approx. date of offense, and specific offense).(Required)Has your license or "right to operate" been suspended or revoked since the age of 18?(Required) Yes No List all incidents where your license or "right to operate" was suspended or revoked since 18 (include state, approx. date, reason, license re-instatement date).(Required)Phone(Required)Your GCC email address(Required) Enter Email Confirm Email Any dishonesty - including the omission of information about driver's licenses, motor vehicle violations, suspensions/revocations - will be grounds for denial of your application.(Required) By submitting this form electronically, I am attesting that all of the information is correct to the best of your knowledge. Further, you are giving permission to the College to perform inquiries about your driver's license status and your driving history.