1. Type of Vehicle
2.
3. Driver 4. Phone
5. Request Date 6. Division
7. Destination
8. Number of Passengers
9. Purpose of Trip
10. Pick Up Vehicle Date 11. Time
12. Return Vehicle Date 13. Time
14. Approved By:
Asst. Supt./Dean/Division Chair Signature
___________________________________________
CERTIFICATION
Please Mark Licensing:
I have a valid Class 3 California Driver’s License
I have a valid Class 2 (Class B) or Commercial
Class C with Passenger Endorsement California
Driver’s License to drive a vehicle with 12 or
more passenger seats.
I certify by my electronic signature below that I have not been issued
more than three moving violations or been responsible for three
accidents or a combination of three of the above during a period of the
last three years, and that the person named in the “Approved By” field
above has approved this request.
Driver’s Signature
Office Use Only
Vehicle #
______
White Trailer
15 Passenger Van
8am
8am
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