Golf Cart Certification "*" indicates required fields Step 1 of 3 33% Please provide complete information in the form against each field. Fields marked with (*) are mandatoryCONTACT INFORMATIONName First Middle Last Address* Street Address 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 Phone*Date of Birth* MM slash DD slash YYYY University Affiliation* Student Faculty/Staff/Graduate Student Class /Year PUID#* Driving for Which Group/Department?* HiddenEmail DRIVING INFORMATIONDriver's License Number* StateNew JerseyAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDriver's License Expiration Date* MM slash DD slash YYYY Upload FRONT & BACK side of Your Driver's License* Drop files here or Select files Accepted file types: jpg, gif, png, Max. file size: 10 MB. DRIVING QUESTIONNAIREVehicles you will drive on University Business Golf/Club Car Is Your License Revoked or Suspended in the US? Yes No Have you Driven at least 2000 Miles in the past Two years? Yes No Have you had any moving traffic violations or accidents while driving a motor vehicle in the past 18 months? if yes, describe below Yes No Description of Moving traffic violations or accidents while drivingDateCity & StateDescriptionPoints on Record Add RemoveSignature* 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 AGREEMENTVehicle 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. Δ