Volunteer – Senior Transportation Services

Thank you for your interest in Senior Transportation Services, Inc. By becoming a STS volunteer driver you can make a difference by providing clients access to health care allowing them to “age in place”.

Volunteer drivers are asked to provide a minimum of 2 rides per month. STS uses a Transportation Software program that allows drivers to accept rides, un-accept rides, record time and mileage. All drivers are given a magnetic sign for their vehicle so that clients can easily identify STS volunteer drivers. We provide supplemental insurance above your own automobile coverage and mileage reimbursement.

Volunteer Driver Registration Form

Today’s Date *

First and Last Name *

Birth Date *

Address *

Street

City

Zip / Postal Code

Phone *

Email *

Ethnicity

Have you received vaccination for COVID? *

Veteran

Referred by

Driver’s License # *

Insurance Carrier *

Copy Automobile Policy Declaration Page *

Drop your file here or click here to upload

Checkboxes *

I certify that I carry at least the minimum automobile insurance as required by the State of Connecticut

Expiration Date *

Policy # *

Copy of Driver’s License *

Drop your file here or click here to upload

Emergency Contact *

Phone *

Volunteer Signature *

Sign with your mouse or touch screen

Captcha *

What is 2+3?

Phone

Driver Background Release Form

I hearby authorize INFORMATION MANAGEMENT SYSTEMS INC. and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment/tenancy/due diligence purposes.

I understand that the scope of the consumer report may include, but is not limited to, the following areas: Verification of social security number, current and previous residences,employment history records from any criminal justice agency in any or all federal, state county jurisdictions, birth records, motor vehicle records to include traffic citation and registration and nd any other public records.

I further authorize any individual, company, firm, organization or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to INFORMATION MANAGEMENT SYSTEMS INC. and its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, organization or public agency may have, to include information or data received from other sources.

I hereby release INFORMATION MANAGEMENT SYSTEMS, INC., the Social Security Administration, and its agents, officials, representatives or assigned agencies including officers, or employees both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family or associates because of compliance with this authorization and request to release.

I understand this authorization automatically expires 90 days from the date executed below and I have the right to revoke the authorization at any time provided I do so in writing.

First Name *

Middle Name

Last Name *

Former Name(s) and Dates Used

Current Address *

Street

City

State

Zip / Postal Code

Current address since *

Former Address

Street

City

State

Zip / Postal Code

Country

Former address since

Former Address

Street

City

State

Zip / Postal Code

Country

Former address since

Date of birth *

Phone *

Driver’s license # *

Today’s Date *

Signature *

Captcha *

What is 2+3?

Comment

No data submitted is saved on our website. A PDF of the form will be sent to our administrative office. Once the background check is processed the prospective driver will meet with our staff to complete a training session, receive software material, copy of insurance coverage and car magnet.

If you prefer to submit your application on paper and mail it in you may use the following forms linked below.

Become a STS Volunteer Driver today and start making a difference in your community. Thank you for considering this volunteer opportunity. We at STS look forward to having you as part of our team.

860-224-7117

Our services would not be possible without volunteers. Please join us!

Volunteer Driver Registration Form

Driver Background Release Form