REQUEST FOR EMPLOYEE DRIVER’S LICENSE AND DRIVING RECORD REVIEW

THIS PROCESS IS REQUIRED PRIOR TO DRIVING STATE VEHICLES

To become an “authorized driver” the individual must:

  1. Be either a state employee or a UNCSA enrolled graduate student whose educational training requires the use of a State-owned vehicle and whose use of the State-owned vehicle is supervised and permitted by an authorized University official. The driver must meet one of these two criteria PRIOR to the driver’s license review.
  1. Possess a valid driver’s license, and
  1. Be approved by the UNCSA Department of Public Safety based on driver’s license verification and driving record review. Excessive driver’s license points or public safety concerns based on the person’s driving record may be grounds for denial.

Instructions: This form is required to request that UNCSA Police and Public Safety conduct a driver’s license verification and driving record review to determine an individual’s eligibility to drive a state vehicle. A person shall not drive a state vehicle until this verification and review is conducted, and the employee/graduate student is approved.

This process must be completed annually.

  1. All items must be completed. Incomplete requests will not be processed.
  2. Enter the requested information on the line provided above.
  3. Attach copy of Driver’s license.
  4. Allow 48 hours for response.

REQUEST FOR EMPLOYEE DRIVER’S LICENSE AND DRIVING RECORD REVIEW

Requesting Department / Fax #
Employee Driver’s Full Name / Date of Birth
Authorized Driver Category
 Currently State Employee
 Graduate student whose educational training requires the use of a State-owned vehicle and whose use of the State-owned vehicle is supervised and permitted by an authorized University official.
Describe the Type of Vehicle(s) and Nature of Driving Duty
Name and Signature of Department Representative
(Authorizing Request) / Date

REQUEST FOR EMPLOYEE DRIVER’S LICENSE AND DRIVING RECORD REVIEW

UNCSA Department of Police and Public Safety Use Only

Date Request Received ______Date Response Sent ______

Approved Denied

Reviewed by: ______

Comments:______

DPPS Form DL 01 711Page 1