Fillable College Vehicle Reservation - Form 1 District and (Palm Beach State College)

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College Vehicle Reservation - Form 1 District and (Palm Beach State College)

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File type: PDF

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College Vehicle Reservation - Form 1
District and Campus Vehicles
Employee Name
Department/Program
Palm Beach State College
4200 Congress Avenue
Lake Worth, FL 33461
Date of Request
Office Ph#
E-mail
Travel
Destination(s)
Departure Time
Out of Town
Phone or Cell#
Travel Purpose
Departing Campus
Lake Worth Palm Beach Gardens
Belle Glade Boca Raton
Date
(applicable only to employees who are requesting and driving the reserved vehicle)
Signature below certifies that you possess a valid Florida driver license and have read and agree to the
Palm Beach State College Vehicle Usage Procedures.
Vehicle will be returned to campus with a FULL tank of gas.
Vehicle Requested
District Vehicle - Contact the office of Vice President,
Administration and Business Services at #868-3455 or
Fax #868-3585
Boca Raton Campus Vehicle - Contact Campus Provost
Office at #862-4401 or 862-4402 or Fax #862-4406
Lake Worth Campus Vehicle - Contact the Campus
Scheduling Office at #868-3234 or Fax #868-3890
Palm Beach Gardens Campus Vehicle - Contact Campus
Provost Office at #207-5401 or Fax#207-5405
Belle Glade Campus Vehicle - Contact Campus Provost
Office at #993-1126 or Fax #993-1129
Supervisor Name
(Please Print)
Provost/VP
Signature
Return Time
Key to vehicle is to be picked up and returned to your home campus Security Office. Please return key immediately upon
returning to campus. Security will sign in/out key and vehicle. Security Office for Lake Worth and Palm Beach Gardens
campuses are open 24/7. Boca Raton Security Office hours are (M-F) 7:30 a.m. - 10:00 p.m. and (Saturday) 7:30 a.m. - 4:00 p.m.
Belle Glade Security Office hours are (M-Th) 7:00 a.m. - 02:00 a.m. and (Friday & Saturday) 7:00 a.m. - 5:00 p.m.
Employee
Signature
A COMPLETED COPY OF THIS CVR FORM AND, IF TRANSPORTING STUDENTS, THE OFF CAMPUS RELEASE LOG SUBMITTED TO
SAFETY AND RISK MANAGEMENT MUST BE MADE AVAILABLE TO THE CAMPUS SECURITY OFFICE PRIOR TO TRAVEL
Provost/VP
(Please Print)
Departure Date
Return Date
For Office Use Only:
Request is Approved Request is Denied
Confirmed by: Date
Name of Secondary
Driver
Supervisor
Signature
Date Signed:
________________
Date Signed:
________________
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College Vehicle Reservation - Form 1 District and (Palm Beach State College)

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Completed 24 August 2020

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