Admin SOP #32 Attachment 5

MOTOR VEHICLE ASSIGNMENT AND USE AUTHORIZATION FORM

CHANGE / CANCEL

Instructions: For employee that is being assigned a different vehicle, please complete Sections 1, 2, and 4-7. For an employee that is being transferred to another Division, Section, or Location, please complete Sections 1, 2 (if necessary), and 3-7. For employee that no longer has a vehicle assigned, please complete Section 1 and 7. Completed forms are to be sent to the DNR Fleet Coordinator for submission to DOAS Office of Fleet Management for approval.

Section 1 – Employee Information

Last Name: ______First Name: ______Employee ID#: ______

Division / Section / Location: ______

CHANGE (Employee being assigned a different vehicle) CANCEL (Employee no longer assigned a vehicle)

Section 2 – Change of Vehicle Information

Current Decal Number: ______New Decal Number: ______

Section 3 – Employee Transfer

From: Division / Section / Location: ______

To: Division / Section / Location: ______

Section 4 – Assigned Vehicle Use: MARK ONLY ONE “YES”

1.Does the State employee drives 14,000 State business miles, in order to routinelyYESNO

conductState business? (This cannot include Commuting Miles)

2.Is the vehicle used to transport equipment that is too large or heavy, or has special YESNO

Featuresthat makes it impractical to be transferred between vehicles or between a

vehicle and a fixedlocation?

3.Is the vehicle required to be driven to sites or under conditions that would endanger YESNO

privately owned vehicles?

  1. Does the employee's position require the individual to perform duties of a YESNO

sworn/POST certified/registered law enforcement officer AND having a vehicle is essential

for the employee to carryout his/her job functions?

Section 5 – Overnight Vehicle Use: MARK ONLY ONE “YES”

Note: Only drivers that qualify for Assigned Vehicle Use (above) can apply for Overnight Use

  1. Thepositionrequirestheemployeetoperformthedutiesof aYESNO

sworn/POSTcertified/registered lawenforcementofficer,andthevehicleassigned

to theemployeeis speciallyequippedforlawenforcementpurposes,andhavingthe

vehicleis essentialfortheemployeeto carryout theirjobfunctions?

  1. Does the employee work out of his/her home and travel to different work sites YESNO

as part of routine duties?

  1. Is there no overnight security at the employee's work site where there is evidence of YESNO

vandalism, and security cannot be obtained for a modest cost nearby?

  1. Does the employee regularly travel directly to remote sites (of sufficient distance for the YESNO

employee to be on travel status) from his or her home, rather than reporting daily to a

central worksite/office?

  1. As a condition of employment, is the driver required to regularly respond directly to theYESNO

sceneof emergencies associated with this position on a 24/7 basis?(Refer to Policy 10,3.3.1

for Vehicle Restrictions/Conditions)

On-call staff must maintain documentation of the number of times they are called to a scene on a month-to-month basis on the Emergency Call-Out Log (Attachment 6). Only those individuals who have 12 call-outs per year will be authorized for overnight use on a routine basis. This information must be documented on the individual DOAS MV-1 form and submitted to OFM.

Must fill in if overnight assigned and NOT POST….

How many miles from house to designated office?_____

Section 6 – Employee Certification

I certify the above listed information is complete and accurate for the purpose of this request.

Employee’s Signature______Date ______

Section 7 – Agency Recommendation

Employee is recommended for authorization of individual

assignment of a vehicle per Section 2.YESNO

Employee is recommended for authorization of overnight

use of the vehicle on a routine basis per Section 3.YESNO

Division Director Signature ______Date ______

Commissioner or Designee Signature ______Date ______

MV1 Update Form

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