El Camino College
Parking Permit Request
EFFECTIVE JULY 1, 2016
TO: El Camino Police Department DATE: __________________________
FROM: _________________________ ________ _______________________ ______________________
Requestor’s Name Ext. No. Division – Full Name Dept. – Full Name
NOTE TO REQUESTOR: PERMIT(S) WILL BE SENT TO YOU VIA CAMPUS MAIL.CERTAIN AMOUNT OF PERMITS WILL NEED TO BE PICKED UP
The following person is an employee of our division/department, and we are requesting that a permit be
issued to her/him.
NAME: LAST __________________________, FIRST________________________ MI _____
(PRINT NAME) (No Nicknames – Bob, Chuck, Mike, etc.)
Datatel No. _________________
EMPLOYMENT CLASSIFICATION: (See “Guidelines for Staff/Student Parking Permit”)
____ Full-time Faculty ____ Part-time Faculty
____ Full-time Classified Staff ____ Part-time Classified Staff
____ Temporary Classified Employee - (ESR – Employee Status Recommendation form #20240 is completed.)
Date Board Approved: ____________ Start Date____________ End Date ____________
Job Title: ______________________________ Job Function: ___________________________
____ Temporary Non-Classified Employee (TNC) – (EC Board Item Employees form #20410 is completed.)
Date Board Approved: ____________ Start Date____________ End Date ____________
Job Title: ______________________________ Job Function: ___________________________
(Permit will not be issued if information is missing)
____ Vendor* - Job Title: _________________________ Job Function: ____________________________________
Work Days _______________________Work Hours – Start:___________ End: ___________Total Hrs./Week_______
Include work days and hours (Permit will not be issued if information is missing)
____ Volunteer* - Job Title: _________________________ Job Function: __________________________________
Work Days _______________________Work Hours – Start:___________ End: ___________Total Hrs./Week_______
Include work days and hours (Permit will not be issued if information is missing)
____ Other - Reason for permit: _________________________________________________________________
Job Title: _________________________ Job Function: __________________________________________
Work Days _______________________Work Hours – Start:___________ End: ___________Total Hrs./Week_______
Include work days and hours (Permit will not be issued if information is missing)
____ Motorcycle Permit ___ Inner Campus Permit
____ Daily Guest Permits – Please order in sets of 25.
____ Grey - (Valid in Student Lots Only – Not Valid in Time Limited Stalls or Staff Lots)
____ Yellow - (Valid in All Lots Except Time Limited Stalls, Red Numbered Reserved and Disabled Person Stalls)
____ Green - (V.I.P. Guest Permit) – Restricted Use –
APPROVED BY: ______________________________ _____________________________
Dean/Director - PRINT NAME Dean/Director’s Signature
PERMIT #___________________ *** FOR CAMPUS POLICE USE ONLY -- DO NOT COMPLETE THIS SECTION ***
____ Full-time Faculty/Staff ____ Part-time Faculty/Staff ____ Temp. Staff ____ Casual/Student
____ Motorcycle Permit ____ Inner Campus (20 min. loading/unloading) ____ Vendor Permit
____ Daily Guest Permit - Amount to be issued _______________ Other: ___________________________________________________
Approved by Campus Police: ________________________ Parking Services:_________________________ Date: _______________
*Doesn’t qualify for Motorcycle Permit Parking Permit Form Revised (Parking Services) 7-2016
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signature
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