Golf Cart Certification

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Please provide complete information in the form against each field. Fields marked with (*) are mandatory

CONTACT INFORMATION

Name

First Middle Last

Address*

Street Address City State ZIP Code

Phone*

Date of Birth*

University Affiliation*

Student

Faculty/Staff/Graduate Student

Class /Year

PUID#*

Driving for Which Group/Department?*

Hidden

DRIVING INFORMATION

Driver's License Number*

State

Driver's License Expiration Date*

Upload FRONT & BACK side of Your Driver's License*

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Accepted file types: jpg, gif, png, Max. file size: 10 MB.

DRIVING QUESTIONNAIRE

Vehicles you will drive on University Business

Golf/Club Car

Is Your License Revoked or Suspended in the US?

Yes

Have you Driven at least 2000 Miles in the past Two years?

Yes

Have you had any moving traffic violations or accidents while driving a motor vehicle in the past 18 months? if yes, describe below

Yes

Description of Moving traffic violations or accidents while driving

Date

City & State

Description

Points on Record

Signature*

I understand that I am required to notify my supervisor if my license is revoked or suspended for any reason. I grant Princeton University the right to check my driving record with any government motor vehicle authority and I authorize Princeton University to access and evaluate my motor vehicle record. I certify that all information provided above is correct and truthful. I understand that any falsification of information or failure to comply with the mandatory regulations may result in the removal of driving privileges and/or disciplinary action.

VEHICLE USAGE AGREEMENT

Vehicle Usage Agreement, Regulations, and Safety Guidelines

All drivers agree to:

Notify their supervisor If their driver’s license is suspended or revoked for any reason.
Report any accidents, damage or moving violations while driving a Princeton University owned or leased vehicle to their supervisor and/or the Departmental Fleet Representative.
Report any accidents, damage or moving violations while driving their personal vehicle on Princeton University business.
Operate vehicles according to Princeton University regulations and applicable state laws.
Assume full responsibility for any fines/penalties resulting from traffic or parking violations arising out of the use of a vehicle while on Princeton University business.

Regulations

All drivers understand that they may not:

Drive a Princeton University owned or leased vehicle while under the influence of alcohol or drugs.
Use a Princeton University owned or leased vehicle for personal business.
Transport hitch-hikers or other unauthorized passengers.

Safety Guidelines

Avoid distractions. Use of a hand-held cell phone while driving is illegal in New Jersey. Pull the vehicle over to a safe area to use a cell phone, use a hands free device, or have a passenger operate cell phone.
Ensure that the vehicle ignition is off and the vehicle is locked when unattended.

Exception: Maintenance Department vehicles in parking lot #12 during working hours.

Drivers and all passengers are required to wear seat belts in University owned or leased vehicles.
During long distance trips, drivers should rotate every two hours. No driver should drive more than 10 hours during a 24 hour period. If there are not enough drivers to rotate, an overnight stay should be planned. Avoid driving past midnight.
Avoid conditions that lead to loss of control—driving while sleepy or inattentive, or driving too fast for road conditions. If weather is inclement, delay trip until conditions improve.

Signature*

I have read and understand the Vehicle Use Agreement, Regulations and Safety Guidelines and agree to comply with them. I understand that any falsification of information or failure to comply with the mandatory regulations may result in removal of driving privileges and/ or disciplinary action.