California State University, Fresno
Home Use Permit
Employee Name: Department:
Employee’s Work Location (BLDG #, ROOM#): Work Phone:
Description
Property
ID#
Serial #
Date
Checked Out
Date
Checked In
Off-Campus Property Location:
I accept responsibility for the California State University, Fresno property, listed above, which has been
issued to me. I understand that:
University Property is to be used only to conduct State business
I may be charged for any loss and/or damage to State property due to my negligence and/or
unauthorized use
The return of University property and the Inventory Coordinator’s signature verifying its return
are necessary before the issuance of my final paycheck
I must keep this form with me whenever transporting property as I may be asked to provide
proof of permission to remove it from the campus
_____________________________________________ ___________
Employee’s Signature Date
_____________________________________________ ___________
Supervisor’s Signature Date
_____________________________________________ ___________
Property Control Officer’s Signature Date
Please make a copy to keep with the equipment and send original back to Property Control
Officer at Mailstop UW127
For Property Services Use
Department: _______________________________________
P-Card/Purchase Order No.: _______________________________________
Name of Contact on Order: _______________________________________