STATE OF ARIZONA



STATE OF ARIZONA

Arizona State University

DRIVER AUTHORIZATION FORM

I understand that as an authorized driver, to operate a personally owned vehicle or fleet motor vehicle for the furtherance of Arizona State University business purposes, I must have an acceptable driver’s record and complete driver training requirements as required by SPP 319 Driver’s License Monitoring and Arizona Administrative Code R2-10-207 12. I understand I must follow Arizona traffic laws, report any change of status to my driving record, and report to my supervisor or manager any involvement in a collision in a state or personally owned vehicle used for state business. I understand suspension of my driving privileges could result in disciplinary action. I understand to drive my personal vehicle for the furtherance of Arizona State University business purposes I must maintain the statutorily required liability insurance. The supervisor / manager may request proof of insurance at any time. I understand The Driver Protection Privacy Act of 1994, amended 9/97, prohibit the release of my MVR data for other than bona fide driver selection and supervision activities.

I understand I must provide a copy of my current driver license and that there will be periodic reviews of my Motor Vehicle Record for the limited purposes noted above.

|      | |      | |      |

|Name (print) | |Affiliate ID | |Date of Birth (mm/dd/yyyy) |

|      | |      |

|Driver License # | |Work Telephone # |

| | |      |

|Signature | |Date |

|      | |      |

|Supervisor’s Name (print) | |Supervisor’s Work Telephone # |

Return the completed form, along with a clear copy of your driver’s license to:

Socorro Meek at OHR, Recruitment & Selection – Mail Code 5612

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