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Each driver who will be operating a vehicle for Campbellsville University activities in fiscal year 2017-2018 must complete a driver authorization application. All drivers of University-owned or leased vehicles must be 20 years old or older and hold a valid U.S. driver license. A license check will be made yearly on each potential driver. A potential driver will be disqualified if the license check reveals any of the following:

1. Conviction for driving under the influence in the last three years

2. Conviction for reckless driving in the last three years

3. Two or more moving violations in the last three years

4. One 6-point violation in the last year.

 

Student drivers under the age of 24 certifying for the first time will be required to watch the driving video, pass a test over that video, and complete a driving training course.

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Do you meet the requirements above?


 

University Affiliation:

 

Are you a new student who will be required to take the driver training course?


Preferred Name

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Last Name:

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First Name:

 

ZIP Code

 

Street Address

 

Address Line 2

 

City

 

State

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Phone

 

UPO Box

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Email Address:

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Confirm Email Address:

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CU ID Number

*

I am the driver named above. By checking next to the numbered items below, I acknowledge that:











 

Traffic Violation History

* If I have received a ticket or citation for a traffic violation (other than parking violations) in the past five years, I have explained fully above.

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Name as shown on Driver License

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Driver License Number

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Driver License State

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Date of Birth

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I am applying to drive for the following organizations, departments and/or athletic affiliations:

 

Age

*

Please check by each box which may apply: