SECTION II - DRIVING RECORD (Continued)
E - RECORD OF CONVICTIONS OPERATING UNDER THE INFLUENCE OF ALCOHOL, NARCOTICS OR PATHOGENIC DRUGS
ACTION TAKENCITY AND STATEDATE
ACTION TAKEN
ORGANIZATION, CITY AND
STATE
DATE
REASON FOR CONVICTION
INFRACTION
F - RECORD OF ABUSE OR NEGLECT TO OR UNAUTHORIZED USE OF GOVERNMENT VEHICLES
SECTION III - APPLICAN'T CERTIFICATION
FALSE STATEMENT IN THIS APPLICATION MAY RESULT IN DENIAL, SUSPENSION, OR REVOCATION OF IDENTIFICATION CARD. I CERTIFY THAT
THE ABOVE STATEMENTS ARE TRUE ADN CORRECT TO THE BEST OF MY KNOWLEDGE.
APPLICANTS
SIGNATURE
DATE SIGNED
SECTION IV - SUPERVISORY REVIEW
APPLICANT IN MY OPINION IS IS NOT CONSIDERED QUALIFIED TO SAFELY OPERATE THE VEHICLE(S) FOR WHICH AUTHORIZATION IS REQUESTED.
SUPERVISOR'S
SIGNATURE
TITLE DATE SIGNED
SECTION V - CERTIFICATION OF ELIGIBILITY AND AUTHORIZATION
TYPES OF VEHICLES AUTHORIZED TO OPERATE
TYPE A - PASSENGER CARS, STATION WAGONS, CARRYALLS, AND TWO-WHEELED DRIVE TRUCKS, ONE TON AND UNDER.
TYPE B - ALL TRUCKS OVER ONE TON AND VEHICLES WITH MORE THAN TWO-WHEELED DRIVE -EXCEPT THOSE LISTED UNDER TYPES C. D. AND E.
TYPE C - TRACTOR-TRAILER VEHICLES, AND OTHER TRAILER PULLING VEHICLES - INCLUDING SEDANS ETC. WHEN SUCH VEHICLES ARE USED TO PULL
TRAILERS.
TYPE D - PASSENGER CARRYING BUSES.
TYPE E - SPECIAL PURPOSE VEHICLES SUCH AS AMBULANCES, FIRE APPARATUS, WRECKERS, CRANES, GRADERS, EARTH MOVING EQUIPMENT, AND
OVERSIZED VEHICLES. (Specify particular type)
SIGNATURE OF CERTIFYING OFFICIAL
ORGANIZATION DATE
REMARKS
IN COMPLIANCE WITH THE PRIVACY ACT OF 1974, the following information is provided: Solicitation of the information is authorized by the Federal Property Administrative Services
Act of 1949, as amended. Authority for solicitation is Executive Order 9397, dated November 22, 1943. Disclosure of the information is voluntary. The principal purposes are (1) to
provide necessary data to determine whether the applicant is competent to operate a federal motor vehicle; and (2) to provide a written record of the applicant's previous driving record,
physical fitness, and ability. The information contained on this form may be transferred outside GSA as a routine use to appropriate Federal, State, or local organizations when relevant
to civil, criminal, and regulatory investigation or prosecution or pursuant to a request by GSA or such other agency in connection with the hiring or retention of an employee, the issuance
of a security clearance, the investigation of an employee, the letting of a contract, or the issuance of a license, grant, or other benefit. Failure to provide requested information may result
in denial of that applicant's request for a motor vehicle operator's identification card.
GENERAL SERVICES ADMINISTRATION
GSA FORM 3607 BACK(6-89)
(Explain if needed)
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