Forms: Driver Authorization

I understand that, as a (COMPANY NAME) driver, I must wear a seat belt at all times in accordance with the

(YOUR STATE) State Law. I understand that I have no authority to allow anyone to drive a (COMPANY NAME) vehicle or give unauthorized rides to non-employees. I understand that (COMPANY NAME) vehicles are to be used only for (co. name) business purposes. I understand that violation of these rules voids all insurance coverage and

renders me liable for all the consequences of my action.

I understand that if I damage a (COMPANY NAME) vehicle, I will be held responsible. Documentation regarding the damage will be placed in my personnel file and may result in disciplinary action up to and including immediate termination.

I understand that if I violate the statutory speed limits in a (COMPANY NAME) vehicle, I may be subject to disciplinary action up to and including immediate termination. Drivers who receive citations for moving violations will be personally responsible for payment of said citations. Citations for parking violations which are incurred while executing (COMPANY NAME) business will be paid by (COMPANY NAME). Exceptions to this are: parking in front of a fire hydrant and other towable violations. In these cases, the driver will pay for any citation, fine and/or towing fee involved. Excessive parking violations will result in a review of driving privileges.

Failure to report any damages, citations or maintenance problems on the day of occurrence will result in disciplinary action up to and including immediate termination. I have read the preceding information and consent to the terms and conditions set forth.

_______________________________________________________________________________________________

Date

_______________________________________________________________________________________________

Signature of Employee

_______________________________________________________________________________________________

Printed Name of Employee

_______________________________________________________________________________________________

Printed Name of Supervisor

_______________________________________________________________________________________________

Signature of Supervisor

NOTE: This form is offered and an example and should be reviewed by an attorney before being used.