VEHICLE REQUEST FORM
Employee Requesting Vehicle Campus Department/Division
| Type of Vehicle | Destination | |||||||||||||
| Number of Persons | Name(s) of Passengers* | |||||||||||||
| Purpose of Trip | ||||||||||||||
| Date/Pick Up Time | Date/Time of Return | |||||||||||||
| Driver’s License # | Expiration Date | |||||||||||||
| *Note: Passenger Liability Waiver Required for All Unauthorized Passengers. | ||||||||||||||
| _______________________________________________ | ______________ | |||||||||||||
| Signature of Employee Requesting Vehicle | Date | |||||||||||||
| APPROVAL: | ||||||||||||||
| ________________________________________________ | ______________ | |||||||||||||
| Supervisor of Employee | Date | |||||||||||||
| _____________________________________________________ | _______________ | |||||||||||||
| Transportation Coordinator (City Park Campus only) | Date | |||||||||||||
| Or Campus/Site Vehicle Manager (designated by Executive Dean) | ||||||||||||||
| Original: Transportation Coordinator or Campus/Site Vehicle Manager (as applicable); Copy: Employee | ||||||||||||||
Form 1382/001 (3/12)
