Half-Time Parking Fee Application - Oregon Department Of Administrative Services
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1Fleet & Parking Services
1100 Airport Rd SE
Salem, OR 97301-6082
Half-time Parking Fee Application
503-378-5090
503-378-2157 fax
(Unreserved lots only: Red, Yellow, Green and Ferry St Roof)
state.parking@oregon.gov
Employee Name:
Employee ID#:
Last
First
MI
Agency Name:
Agency Number:
Division/Section:
Worksite Address:
Street/City/Zip
Telephone:
Email:
(For any communications regarding your parking assignment)
I hereby certify that I will use the parking permit 20 hours or less per week.
I hereby certify that I am a telecommuter, using the parking permit 20 hours or less per week.
Telecommuting requires certification from supervisor:
I hereby certify that the above named employee is telecommuting _____ days per week.
Supervisor name:
Supervisor signature:
Date:
I understand that parking regulated by the Department of Administrative Services is subject to the
provisions of OAR Chapter 125, and ORS Chapters 98, 276, 283, and 292. By accepting a parking
assignment made by the Department, I agree to abide by these rules and laws. I further understand that
failure to abide by these rules and laws may result in citation, prosecution and/or loss of parking privileges.
I will notify DAS State Parking within 48 hours of any changes to my parking or work schedule.
Employee signature:
Date:
U:\PKG\Forms\HalfTimeApplication.docx
Updated 8/25/2017 ICD
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