APPROVED
DISAPPROVED
VEHICLE NOT AVAILABLE REASON:
CREDIT CARD ISSUED:
YES
NO
STATE CREDIT CARD #:
VEHICLE LICENSE #:
VEHICLE ID #:
STARTING MILEAGE:
ENDING MILEAGE:
DIRECTOR OF TRANSPORTION:
Signature
DATE:
DEPARTMENT:
DEPARTURE TIME:
RETURN TIME:
PURPOSE OF TRIP:
OTHER LCC EMPLOYEES/STUDENT PASSENGERS TO RIDE WITH YOU:
NAME: DEPARTMENT:
NUMBER OF STUDENTS TRANSPORTED (attach list of names to form):
TYPE OF VEHICLE REQUESTED:
TO BE COMPLETED BY TRANSPORTATION DIRECTOR
1. Vehicle Request form must be submitted five (5) working days prior to trip.
2. It is the drivers responsibility to perform pre-trip and post-trip inspection of vehicle.
3. Travel request must be approved by the cogent administrator, i.e.., President and/or
Vice-President before vehicle request will be considered approved.
4. Drivers must have current driver's license.
5. No unauthorized drivers or passengers are allowed in vehicles. (LCC Employees/Students Only)
6. Vehicles may be picked up at the Motor Pool one hour prior to trip.
7. Vehicles must be returned to the Motor Pool immediately after trip.
8. Vehicles shall be free of trash when returned to the Motor Pool.
9. State credit card shall be used solely for the purpose of purchasing fuel for school
vehicles from self-service gas stations.
10. Personnel not abiding by the above will lose privileges to operate any LCC vehicle.
NAME:
DATE OF TRIP:
DATE OF RETURN:
TITLE:
DESTINATION:
DRIVERS NAME: DRIVER'S LICENSE #:
DRIVER'S SIGNATURE:
DATE:
ALTERNATE DRIVERS NAME:
DRIVER'S LICENSE #:
ALTERNATE DRIVER'S SIGNATURE:
DATE:
APPROVED BY:
Supervisor
DATE:
VEHICLE REQUEST FORM
Print form on Blue paper
Enter information below, print, sign and submit to Physical Plant Office
