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2. Please complete this form to register if you are regularly using an alternative way to and from work. Submitting this form allows the City of Bothell’s Employee Transportation Coordinator (ETC) to create a RideshareOnline.com account for you. You will use the RideshareOnline.com account to track your alternative commute trips and participate in reward programs. For each month you meet the threshold of 60-89% of alternative commute trips, you will receive $20 in the form of a MasterCard® credit. A $30 credit is given in the months in which your alternative commute trips are 90% or above. Additional incentive programs are available through RideshareOnline.com or you can contact your ETC. To receive rewards, you must submit this completed form to the ETC, and you must have all of your alternative commute trips recorded on the RideshareOnline.com calendar. Alternative trip logs must be updated by the 5th day of the following month (i.e. by March 5th for February commute trips). It is the Employee’s responsibility to submit a revised form when work or personal addresses change. The employee needs to notify the ETC in writing if they no longer use an alternative way to work. The ETC may at any time request updates to this form or RideshareOnline.com accounts. It is the employee’s responsibility to report a lost or stolen MasterCard®. The employee is responsible for the replacement fee for the card.
4. Questions about this form or the program can be submitted to the Employee Transportation Coordinator at hae.choe@bothellwa.gov.
8. Employee Contact Information
10. First Name*
11. Last Name*
13. Work Phone Number
14. Work Email Address
15. Department*
    -- Select One --ClerksCity Manager's OfficeCommunity DevelopmentCommunity Risk ReductionCourtFinanceFire & EMSGISInformation ServicesHuman ResourcesLegalParks & RecreationPolicePublic Works
17. City Facility You Work at:*

    1. City Hall
    2. Bothell Operations Center
    3. Police
    4. Fire (Downtown)
    5. Fire (Canyon Park)
    6. Fire (Queensborough)
18. If located at City Hall, have you read City Hall Administrative Order #3.0.1
    -- Select One --YesNo
19. Are you requesting a locker?
    -- Select One --YesNo
21. Your Home Address and Commuting Information
23. Address*
25. City*
26. State
27. Zip Code*
29. Home Phone Number
30. Cell Phone Number
32. Nearest Two Cross Streets to your Home Address
34. Modes of Transportation you Use*

    Which method(s) are you using as an alternate to a Single Occupancy Vehicle (SOV)?

    1. Carpool
    2. Bicycle
    3. Transit
    4. Walking/Jog/Run
    5. Vanpool
36. If carpool or vanpool, list the names of people riding with you
38. Commute Start Time
39. Time you leave work
41. CTR Policy Employee Agreement*

    I certify that I will utilize the above mode(s) of transportation as stated above. Should any changes occur in my participation program, I will immediately notify the City of Bothell’s ETC. I understand that I am eligible for the Commute Trip Program MasterCard incentive as long as I use an alternative way to and from work at least 60% of the days worked in a month (an average of three days worked per week) and report those hours by the 5th day of the following month in the RideshareOnline.com tool. I have read the policies and procedures for participation in the City’s Employee CTR Program and agree to the terms. I understand the ETC may verify this information at any time.

    1. Agree
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field