Transportation Waiver - Non-Driver

Date*

By completing below I acknowledge that I understand and agree that as a non-driver I will not under any circumstances transport a Choices In Community Living client or do any work on behalf of Choices In Community Living that would require driving an agency vehicle or my personal vehicle until the time when documentation is provided.

By completing below I acknowledge that I understand and agree that as a non-driver I will not under any circumstances transport a Choices In Community Living client or do any work on behalf of Choices In Community Living that would require driving an agency vehicle or my personal vehicle until the time when documentation is provided.*

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Staff Signature

Staff Name*

First Name

Last Name

Date*

Note: Program Director, Program Administrator or Human Resources Representative sign and date below before adding to file & Provide.

Transportation Waiver - Non-Driver Personal & Agency Vehicle