Authorization To Operate State Vehicles And Private Vehicles On State Business Form printable pdf download

Authorization To Operate State Vehicles And Private Vehicles On State Business Form

ARKANSAS STATE VEHICLE SAFETY PROGRAM

AUTHORIZATION TO OPERATE

STATE VEHICLES AND PRIVATE VEHICLES ON STATE BUSINESS

The following must be completed and signed before authorization to drive on state

business will be given.

Agency Code__________

Agency_______________________________________ Division_______________________

Employee Name______________________________________________________________

Date Of Birth ______/_______/__________

yyyy

Drivers License Number___________________________

Initial Each of The Following:

____I understand that as permitted by Arkansas Code Ann. §27-50-906 (6)(A), the Office of

Driver Services will notify my employer each time a new violation is added to my driving

record. I also understand that my employer has access to my driving record through the

SVS System (State of Arkansas Website) through Information Network of Arkansas.

____I understand that because of my driving record I may not be permitted to drive on state

business.

____I will participate in all required Defensive Driving Classes.

____I will report all accidents that occur on state business to my employer 1)within 24

hours of the occurrence or by the next working day if the accident occurs in a state vehicle

and 2)within 7 working days if the accident occurs in a private vehicle.

____I have read the Driving Safety Tips provided by my employer.

____I understand that I must maintain liability coverage, as required by state law, on my

personal vehicles that I drive on state business.

Employee Signature

______/_______/___________

Date

VSP-1

Authorization To Operate State Vehicles And Private Vehicles On State Business Form