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Appendix D

Van Operation

Longwood University Police Department

I understand the below listed information regarding the Longwood fifteen (15) passenger van policy, and I have had the opportunity to ask for clarification of all items. Furthermore, I understand that signing this document grants permission to the Longwood Public Safety Department to access my driver's history information.

  • I have authorized the Longwood Public Safety Department to validate the status of my driver's license and access my driving history prior to a road test. I will not be permitted to operate a van on Longwood sponsored activities if I have been convicted of a serious traffic offense, have had three (3) accidents, or three (3) speeding tickets within the past three (3) years.
  • I have agreed to complete a driving test under Longwood Public Safety Department supervision. This is a standardized test and the results will be maintained on file for a minimum of three (3) years.
  • I have been shown where the spare tire, jack, etc. are located. I have also been informed to contact the Police Dispatch at 434.395.2091 should a more serious maintenance problem occur.
  • I have been shown the location of the instructions "When You Have An Accident." I have read these instructions. I have been made aware that should I have an accident, I am not to move the vehicle before the police arrive at the scene and authorize me to do so.
  • I agree that I will wear my seat belt. It is the law.
  • I have been instructed in the use of and location of gas credit cards. I understand they must have the vehicle license number, mileage and a legible signature. I am also aware that the receipts are to be turned in with the keys at the end of the trip.
  • It is my responsibility to leave the van clean. All trash is to be removed.
  • I am aware that smoking and the consumption of alcoholic beverages in state owned vehicles are prohibited.

Printed Name:___________________________________
Signature:______________________________________
SSN:______________________DOB:_________________
Officer's Name (Printed): ___________________________
Signature:______________________________________