Fillable Form 1: DRIVER AUTHORIZATION FORM All Drivers of (St. Lawrence University)

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Form 1: DRIVER AUTHORIZATION FORM All Drivers of (St. Lawrence University)

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______________________________________________________________________________________________________
___________________________________________________________________ ___________________________________
DRIVER AUTHORIZATION FORM
Recertification_______
1
st
Training _________
All Drivers of University Owned Vehicles Must Be Approved Annually
1. Complete and sign the form - have your supervisor sign - take to The Safety and Security Department (76 Park St. Ground Floor) for training (if
necessary) and DMV license check.
2. Provide copy of your driver’s license with the application.
3. Completed form with copy of license check will have final approval by Director of Safety and Security and distributed to the approved driver
listings maintained by Safety and Security.
4. This form must be completed and approved on an annual basis by October 15th.
ALL STUDENTS AND ALL VAN DRIVERS MUST COMPLETE THE DRIVER TRAINING
DRIVER TRAINING ONLY NEEDS TO BE SUCCESSFULLY COMPLETED ONCE TO BE AUTHORIZED TO DRIVE AN SLU VEHICLE.
NAME___________________________________________________DATE OF BIRTH______________YR.GRADUATED_______
(PLEASE PRINT OR TYPE)
ADDRESS – Campus SMC #__________ DORM_______________________________PHONE #___________________________
Home-_____________ ____________________________________________________________________________________
(Street) (City) (State) (Zip Code)
DRIVER’S LICENSE_____________ __________________________ __________ _______________ _______________________
Please attach a copy (Number) (Class) (State of Issue) (Expiration Date)
of your license
List all accidents or convictions within the last 24 months:__________ _____________________________________________
Years of Driving Experience ______________________
*** STUDENTS*** WOULD YOU BE WILLING TO DRIVE FOR OTHER DEPARTMENTS? _____________
I certify that the information presented above is correct and that I will report any change to the University promptly.
I hereby authorize the University to obtain a Department of Motor Vehicles’ report of my driving records.
(SIGNATURE) (DATE)
Department Name ___________________________________________________ ___________________________________
(work for or sponsored by) (DATE)
Department Supervisor’s _________________________________ ___________________________________
Signature (PRINT NAME)
DMV CHECK & APPROVAL OF LICENSE BY
____________________________
Date
______________
Driver Training Course Completed: Date____________ Signature of Trainer__________________________
Van Authorized ____________Yes _______________No
Assistant Vice President Safety & Security and Emergency Management ___________________________________________________Date
_____________________
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Form 1: DRIVER AUTHORIZATION FORM All Drivers of (St. Lawrence University)

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Completed 27 August 2020

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