Csc 665 Form PDF Details

At first glance, the CSC 665 form may seem like just another piece of government paperwork, but its role is crucial in ensuring that individuals applying for positions that require the operation of motor vehicles or mobile equipment are suitably qualified and possess a strong record of driving safely. This form, authorized by the United States Civil Service Commission and bearing the Budget Bureau number 50-R0279, serves as an Experience Statement Sheet for potential motor vehicle and mobile equipment operators. It meticulously collects general information, including the position applied for, personal details, and address, but delves deeper into the applicant's driving history, focusing on traffic violations, driver's license specifics, accident records, and any safety awards received. The form requires applicants to disclose traffic violations and accidents from the past five years, excluding parking tickets or incidents where the applicant was found not guilty. It also inquires about driver's license details, such as the permit or license number, issuance state, expiration date, and any restrictions. Additionally, the form requests information on safety awards or citations for safe driving, highlighting the applicant's commitment to safe operation on the road. This detailed reporting mechanism plays a vital role in promoting road safety and responsible vehicle operation within civil service roles, ensuring that only those with proven ability to drive safely are considered for positions that demand such qualifications.

QuestionAnswer
Form NameCsc 665 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescsc 665 ability to drive, cscform 665, csc form service safely, csc form 665 safe driving form

Form Preview Example

UNITED STATES CIVIL SERVICE COMMISSION

Form Approved

ABILITY TO DRIVE SAFELY

Budget Bureau No. 50-R0279

Experience Statement Sheet for Motor Vehicle and Mobile Equipment Operators

 

Please fill in both sides of this Form. You may have someone help you complete it if you wish.

A. General Information

1. Title of position applied for

2. Date

2. Name (first, middle, last)

4.Birth date (Month, day, year)

5.Address (Number and street, or RD number, city, State, and ZIP Code)

B.TRAFFIC VIOLATIONS. (Supply the information requested below for each time you were given a ticket or arrested for breaking a driving law during the past 5 years. Do not include any record where you were found not guilty. Also do not include parking tickets.)

 

Type of violation

Mo/Yr.

While

City, County, State

License

Fined or

Sen-

 

 

 

on job?

 

revoked or

forfeited

tenced?

 

 

 

 

 

suspended?

collateral?

 

 

 

 

 

 

 

 

 

1

 

 

Yes

 

Yes

Yes

Yes

 

 

 

No

 

No

No

No

 

 

 

 

 

 

 

 

Details of action taken (Length of suspension, amount of fine, etc.)

 

Type of violation

Mo/Yr.

While

City, County, State

License

 

Fined or

Sen-

 

 

 

on job?

 

 

revoked or

 

forfeited

tenced?

 

 

 

 

 

 

suspended?

 

collateral?

 

2

 

 

Yes

 

 

Yes

 

Yes

Yes

 

 

 

No

 

 

No

 

No

No

 

 

 

 

 

 

 

 

 

 

 

 

Details of action taken (Length of suspension, amount of fine, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of violation

Mo/Yr.

While

City, County, State

License

 

Fined or

Sen-

 

 

 

on job?

 

 

revoked or

 

forfeited

tenced?

 

 

 

 

 

 

suspended?

 

collateral?

 

3

 

 

Yes

 

 

Yes

 

Yes

Yes

 

 

 

No

 

 

No

 

No

No

 

 

 

 

 

 

 

 

 

 

 

 

Details of action taken (Length of suspension, amount of fine, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Driver's License Information

 

 

 

 

 

Driver's permit or license number

 

 

State in which it was issued

 

Date it expires

 

 

 

 

 

Restrictions listed in present license

 

 

Other States where you obtained license during the past

 

 

 

 

 

5 years

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CSC Form 665

D.ACCIDENT RECORDS. (Complete the information requested for each accident you have had during the past 5 years---

whether your fault of not.)

 

Type of accident (Head-on collision, hit a tree, etc.)

 

Mo/Yr.

 

While

 

City, County, State

 

 

 

 

 

 

 

 

 

 

 

 

on job?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount of damage to

Amount of damage to

 

Did you or your insurance company make payment to the other

 

your car

 

the other party's car

 

party?

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

$____________

 

If "Yes," give amount, $______________

No

 

$_____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Was anyone killed?

Yes No

 

 

 

Were you judged at fault?

Yes

No

 

 

 

 

 

 

 

 

 

 

Describe charges placed against

License

 

Fined or

Sen-

 

Details of action taken (sentence,

 

you, if any

 

 

revoked or

 

forfeited

tenced?

length of suspension, amount of fine,

 

 

 

 

suspended?

 

collateral?

 

 

etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

Yes

 

 

 

 

 

 

 

 

 

 

No

 

No

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of accident (Head-on collision, hit a tree, etc.)

 

Mo/Yr.

 

While

 

City, County, State

 

 

 

 

 

 

 

 

 

 

 

 

on job?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

Amount of damage to

Amount of damage to

 

Did you or your insurance company make payment to the other

 

your car

 

the other party's car

 

party?

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

$____________

 

If "Yes," give amount, $______________

No

 

$_____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Was anyone killed?

Yes No

 

 

Were you judged at fault?

Yes

No

 

 

 

 

 

 

 

 

 

 

Describe charges placed against

License

 

Fined or

Sen-

 

Details of action taken (sentence,

 

you, if any

 

 

revoked or

 

forfeited

tenced?

length of suspension, amount of fine,

 

 

 

 

suspended?

 

collateral?

 

 

etc.)

 

 

 

 

 

 

 

Yes

 

Yes

Yes

 

 

 

 

 

 

 

 

 

 

No

 

No

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Safety Awards

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever received a safety award?

If yes, give details, including date received

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever received a citation for safe

If yes, give details, including date received

 

 

 

driving or for being a safe worker?

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you had more than three traffic violations or two accidents within the last 5 years, provide the information requested in B and D above for each on additional sheets.

I certify that all of the statements made in this application are true, complete, and correct to the best of my knowledge and belief and are made in good faith.

Signature of applicant

Date

 

 

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1. To get started, when filling out the csc 665 driving form boston, beging with the form section containing subsequent blank fields:

Step no. 1 for completing form csc 665

2. After finishing the previous section, go on to the subsequent step and enter the necessary details in all these fields - Type of violation, MoYr While, City County State, on job, Yes No, Details of action taken Length of, Type of violation, MoYr While, City County State, on job, Yes No, Details of action taken Length of, License revoked or suspended Yes, Fined or forfeited collateral Yes, and Sen tenced.

Yes  No, Fined or forfeited collateral Yes, and License revoked or suspended Yes inside form csc 665

3. Completing Restrictions listed in present, Other States where you obtained, and CSC Form is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

form csc 665 completion process clarified (step 3)

You can certainly make errors while filling in the Restrictions listed in present, consequently you'll want to take another look prior to when you submit it.

4. The subsequent paragraph needs your input in the subsequent parts: Type of accident Headon collision, MoYr, City County State, While on job Yes No, Amount of damage to your car, Amount of damage to the other, Did you or your insurance company, If Yes give amount, Yes No, Was anyone killed, Describe charges placed against, Yes No License revoked or, Were you judged at fault Yes, Fined or forfeited collateral, and Sen tenced. Ensure that you fill in all of the requested info to move forward.

Completing section 4 of form csc 665

5. Lastly, the following last part is precisely what you should complete before submitting the PDF. The fields under consideration are the following: Describe charges placed against, Yes No License revoked or, Fined or forfeited collateral Yes, Sen tenced, Yes No, Details of action taken sentence, Have you ever received a safety, Yes, E Safety Awards, If yes give details including date, Have you ever received a citation, Yes, If yes give details including date, If you had more than three traffic, and I certify that all of the.

Filling out section 5 in form csc 665

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