Field Tip Driver Notifications and Form
Policy Code: 6315 Drivers
Safety is of paramount concern in providing student transportation services. Consistent with the
board's goals for student safety, all drivers involved in transporting students, including activity bus
drivers, must comply with the following board requirements. Failure to comply may result in
suspension or dismissal of the driver by the school principal.
Volunteer drivers:
• will possess required licenses and all other qualifications required by law;
• will report to the principal by the next working day any moving violation citations received while
operating any motor vehicle, whether on or off duty; and
• will carry insurance if operating a privately owned vehicle.
From Board Policy 3320: When privately owned vehicles are used, the driver must be notified in writing
that his/her personal automobile liability insurance is the primary carrier in case of an accident.
This is your notification.
Because of the policies stated above, we need a copy of your driver’s license and current insurance card. (We
can make the copies at school for you!) By attaching your driver’s license and insurance information, you
are acknowledging that you understand and accept all policies stated in this form.
All drivers are also chaperones. This requires you to complete the volunteer profile form (on the back). The
volunteer profile form only has be completed once each school year, unless information changes. Once this
information is accepted, you will be placed on a list of approved chaperones and drivers for the remainder of the
school year for any field trip for any group. There is one notable exception. Overnight field trips have to
complete new forms, submit new copies, and submit to a background check. (School employees and coaches
have already submitted to background checks and do not need to complete the Volunteer Profile Form.)
To help ensure the safety of our students, it is necessary to clearly define the expectations that we have for our
chaperones. While these expectations are not intended to limit your personal freedoms, the safety and education
of our students must take precedence.
Conduct:
-No inappropriate language, jokes, suggestions, or gestures.
-Do not take a picture, video, or record students in any fashion, other then your own child.
-Do not be alone with a student in an isolated area (for example: being alone with a student in a hotel
room).
-Do not take ANY substance that may impair your judgment (for example: alcohol, medication).
-Follow all local, state and federal laws.
-Do not allow or facilitate students breaking school policies and rules.
-Do not allow or facilitate students breaking the law.
-Make the safety of the students your highest priority.
If you see or suspect that a student is breaking a school policy or the law, it is your responsibility to inform your
group leader immediately.
It is the group leader’s responsibility to provide disciplinary action as needed.
If you believe that a student’s health is in danger, take all appropriate action and inform the group leader.
Iredell-Statesville Schools
VOLUNTEER PROFILE FORM
The Iredell Statesville Schools has developed a volunteer/chaperone screening process to help ensure the safety of our children.
Chaperones for day field trips should complete section I and II of this form and return it to the school principal at least 7 days
before the date of the field trip. Chaperones for overnight field trips should complete section I, II, and III of this form and
return to the school principal at least 14 days before the date of the field trip. You may read a copy of School Board Policy 3320
by visiting our website (www.iss.k12.nc.us).
Section 1: Volunteer Contact Information
Trip Date: ___________________
Date __________________ Student Name_____________________________ School Name ____________________Grade______
First Name _________________________ Middle/Maiden ___________________ Last Name ______________________________
Home Address, City, State, Zip __________________________________________________________________________________
Home Phone _______________________________________ E-mail Address ____________________________________________
Employer __________________________________________ Business Phone ___________________________________________
Business Address, City, State, Zip _______________________________________________________________________________
Have you ever been employed by I-SS?
Yes
No
If yes, give dates of employment:
_____________________________
Section 2: References
Please print. Complete the following information for three non-family references.
1.
Name__________________________________________________ Relationship __________________________________
Address _____________________________________________________________________________________________
Street
City
State
Zip
Phone____________________________________ How long have you known this person? __________________________
2.
Name__________________________________________________ Relationship __________________________________
Address _____________________________________________________________________________________________
Street
City
State
Zip
Phone____________________________________ How long have you known this person? __________________________
3.
Name__________________________________________________ Relationship __________________________________
Address _____________________________________________________________________________________________
Street
City
State
Zip
Phone____________________________________ How long have you known this person? __________________________
I authorize I-SS to contact the references I have listed.
_________________________________________
Signature
Date
_____________________________
Section 3: Background Check Information and Consent
BACKGROUND CHECK RELEASE AUTHORIZATION
In consideration of my application to volunteer, I authorize Iredell-Statesville Schools by and
through North Carolina Administration of the Clerk of Courts and/or by and through QPI or
another selected agency or source to verify all data given by me on application, related papers
or oral interviews. I understand a thorough investigation may be conducted which may
include, but not be limited to criminal history, motor vehicle driving record. I state that the
information provided by me on my application is accurate and I agree that if any information
therein is found to be false at any time, my application may be discarded. I understand that
the information requested below regarding sex, race and date of birth are for the sole purpose
of gathering the above information accurately and will not be used to discriminate against me
in violation of the law. A facsimile (Fax) or photocopy of this authorization shall be as valid
as the original.
___________________________________________
Applicant’s Full Name (Please Print)
__________________________________________
Social Security Number
___________________________________________
Maiden or other names used
___________________________________________
Date of Birth
Race
Sex
___________________________________________
Driver License Number/
State issued
___________________________________________
Applicant’s Signature
Date
This form must be filled out in its entirety. We do not share information and will keep your confidential information private. You DO
have to provide us your social security number for our check. If this is left blank, a check will not be performed. If you have questions
about this process please call Alisha Johnson at 704-924-2053.
Do you plan on transporting students? ___________
If yes, please provide a copy of your driver’s license and current insurance card.
Is this an overnight field trip?
Yes_______
No_______
Have you have chaperoned on an overnight field trip before and we have already performed an
initial background check? Yes________ NO________ if yes, when? ____________
Iredell-Statesville Schools maintains certain records on volunteers. In accordance with Section 115C-209.1 of the North Carolina
General Statutes, those records are not public records and shall not be open to inspection, except in accordance with that law. A copy
of this law can be seen on the I-SS website (www.iss.k12.nc.us.).
***For Office Use Only***
RECD:
SSN Scan___________
Fax Profile Form to: 704-872-2553 attn: Alisha Johnson
COMPLETED:
HRMS:
Comments/Approval:
Alias_______________
NC________________
OOS_______________
special instruction needed___________________
Rev. 03/18/2010