Fillable VEHICLE USE REQUEST FORM

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VEHICLE USE REQUEST FORM

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The VEHICLE USE REQUEST FORM form is 2 pages long and contains:

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  • 38 check-boxes
  • 15 other fields

Country of origin: US
File type: PDF

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VEHICLE USE REQUEST FORM
Name or Program:
Vehicle Requested:
Destination:
Date and Time of Departure:
Date and Time of Return:
Reason for Request:
Signature:
Facilities Signature: Date:
Date:
Page: 1 of 2
President’s Signature:
Approved: Denied:
Date:
• Requests must be submitted one week in advance.
• College use takes priority.
• If the request is approved the beginning and ending mileage will be provided to the
facilities manager aer return from destination.
Fund Number (If Applicable):
12/7/2017
Vehicle Use Questionnaire
1. Do you have a current State and Tribal Driver’s License?
2. Has your driving privilege been revokes in the past three (3) years?
3. Have you had two (2) or more suspensions with reinstatement?
4. Have you had two (2) or more at fault accidents?
5. Have you had three (3) or more moving violations?
6. Have you had a combinations of three (3) or more moving violations,
at fault accidents and suspensions with reinstatement?
7. Have you been found guilty of the following:
A. DUI or DWI? If so when:
B. Failure to stop and report accident with injury?
C. Vehicular homicide, manslaughter or assault?
D. Driving aer revocation or suspension?
E. Operating a vehicle without owner’s permission?
F. Operating a vehicle during commission of a felony?
G. Racing or speed contest?
H. Attempting to elude a police ocer?
I. Underage passenger with an open container?
J. Reckless or careless driving?
K. Driving on wrong side of the highway?
L. Hit and Run?
YES NO
Page: 2 of 212/7/2017
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VEHICLE USE REQUEST FORM

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Completed 27 July 2020

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