USPS Safe Driver of the Year Award Application

Section A: Nominator Information (please print)

Date Submitted

mm/dd/yyyy

Membership Id # (of location)

Company Name

Company Street Address (No PO Boxes)

City

State

Zip

Application Submitted by

Title

Phone

Email (REQUIRED: Winners notified by email)

Section B: Nominee Information (please print)

Driver Name

Area

Placeholder list - please provide the actual area options to finalize this field

Total # of years driven without a preventable collision throughout career

Total # of miles driven without a preventable collision throughout career

# of safe driving years employed with current company

# of safe driving years employed with previous company (if any)

Total # of preventable incidents during career

Dates of preventable collision (MM/DD/YYYY)

Type of vehicle(s) authorized to operate

Please write a brief statement that you feel is relevant for the consideration of this nominee.

Permission to Contact You

I agree to receive communications from NSC

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