Application for Permanent Assignment of Passenger Vehicles

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Application for Permanent Assignment of Passenger Vehicle

Person Assigned to or Responsible for the Vehicle

Name:

* *

Drivers License No.:

*State Driver's License Issued From: *

Position Title:

Work Phone No:

Ext: **

Work Mailing Address:

*(if working from home, enter home address)

Work City:

* Zip: *Courier/MSC:

Email:

* *

Vehicle Usage:

Department or Institution Information

Department:

* *

Company:

* Fund No.: * Agency Management Unit: * Agency Program: Funding Source: Project:

Division, Office or Agency Information

Name:

Phone No:

Ext: * *

Address:

City:

* Zip: Courier/MSC:

Address Vehicle Will be Parked:

* City: *

County Vehicle Will be Parked:

Additional Information

Section(if applicable):

District(if applicable):

Vehicle Needs

Date Needed(mm/dd/yyyy):

* *

How Long Needed:

Expected Yearly Mileage Use:

Why Vehicle is Needed and
How it Will be Used:

Type Vehicle Needed:

Commuter Information

Office In home?

Yes

Only complete if Office is not in home and individual qualifies to drive vehicle home.

How do they qualify to drive vehicle home?

None of the following

Ambulance or hearse

Clearly marked police, fire or emergency response vehicle

Delivery truck with seating only for driver

Department Secretary, Council of State Head or Chancellor

DOT Emergency Maintenance

Specialized utility repair vehicle(except van or pickup truck)

Unmarked law enforcement vehicle driven by full-time sworn law enforcement officer whose primary duties include carrying firearm, executing search warrants and making arrest

Reason driver required to drive after duty hours.

Round trip distance to driver's residence.

Position No.: