07/01/2011 DA 2054 STATE OF LOUISIANA DRIVER AUTHORIZATION FORM TO BE COMPLETED ANNUALLY, UPON CHANGE OF STATE OF ISSUANCE, CLASS OF LICENSE, AND/OR DRIVING RESTRICTION CHANGE Agency: ____________________________ Employee Name: _____________________ Employee Number: __________________________ Immediate Supervisor: _________________ Driver Training Course (MM/DD/YY):_____________ Drivers License Number: _______________ State of Issuance: ___________________________ AGENCY HEAD OR DESIGNEE AUTHORIZATION...
Allowed
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