APPLICATION AND SCORING RECORD

                                                                                    I. PERSONAL DATA

APPLICANT’S NAME_________________________________________________DATE_________________

UNIT_______________________________________________________________RANK_________________

SSN_________-______-________DATE OF BIRTH*_______________CORRECTIVE LENSES     Y     N

COLOR OF EYES_______ COLOR OF HAIR__________ WEIGHT_________ HEIGHT IN INCHES_______

DRIVERS LICENSE NUMBER_______________________ STATE________ EXP DATE_________________

RESTRICTIONS______________________________ENDORSEMENTS_______________________________

INSTRUCTIONS: UNITS NEED TO COMPLETE THE HEADING (PART I) AND THE "UNIT " (PART II) PORTIONS OF THIS APPLICATION.

ADDITIONALLY, UNITS NEED TO RECORD THE RESULTS OF THE HEARING TEST (FROM THE SOLDIER'S LAST PHYSICAL) ON PART IV OF

THIS FORM. THIS FORM MUST ACCOMPANY THE SOLDIER WHEN HE/SHE REPORTS FOR TRAINING. WHEN THE TRAINING IS COMPLETED,

IT WILL BE RETURNED TO THE UNIT TO BECOME A PERMANENT PART OF THE SOLDIERS DRIVING RECORD. ALL PORTIONS OF THIS

FORM MUST BE FILLED OUT COMPLETELY PRIOR TO THE UNIT ISSUING A LICENSE.     * THE SOLDIER MUST BE 21 YEARS OLD.

CHECKLIST

II. UNIT

 

CMDR INITIAL

DATE OPERATOR INITIAL DATE

*VALID DRIVERS LICENSE

       

DRIVERS BADGE

       

*COMMANDERS INTERVIEW

       

DRIVERS RESPONSIBILITIES/GOVERNMENT LIABILITY

       

STATE AND LOCAL TRAFFIC REGULATIONS

       

*USE OF ARMY PUBLICATIONS AND FORMS

       

*PMCS/VEHICLE INSPECTION

       

ACCIDENT AVOIDANCE

       

DRIVER ENERGY/ENVIRONMENTAL CONSIDERATION

       

RESPONSE TO VEHICLE MALFUNCTION

       

DEFENSIVE DRIVING

       

*MANDATORY REQUIREMENTS-THE REST ARE STRONGLY SUGGESTED

 

                                                                                          III. SCHOOL

GO/NO-GO

INSTR
INITIALS
OPERATOR INITIALS DATE

PHYSICAL MEASURES TESTING

       

INTRODUCTION TO BUS/BUS VS. CAR- KNOW YOUR EQUIPMENT

       

PMCS ON THE BUS- INSTRUCTION

       

TRANSPORTING PASSENGERS ON A BUS- INSTRUCTION

       

AIR BRAKES SYSTEMS- INSTRUCTION

       

RANGE FAMILIARIZATION

       

ROAD DRIVING

       

NIGHT DRIVING

       

AIR BRAKES EXAM

       

BUS/PASSENGER EXAM

       

PMCS EXAM (HANDS ON)

       

DRIVING PERFORMANCE EVALUATION (RANGE)

       

DRIVING PERFORMANCE EVALUATION (ROAD)

       
         
         

                                                                           IV. PHYSICAL MEASURES TEST

LT EYE 20/______RT EYE 20/_____ FOV LT EYE ______ RT EYE ______

DEPTH PERCEPTION____________________ COLOR PERCEPTION_________________

REACTION TIME____________/100 __________/100

HEARING LEFT________ RIGHT ________ DATE __________