FS-12 Driver Agreement

All University staff and other individuals including students and contractors intending to use a vehicle for University business must complete this form and have it AUTHORISED appropriately. A copy is to be retained by the appropriate department manager.

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First name

Last name

Email Address

Phone Number

Date of birth

(must be over 21 years of age)

Driver Licence Number

Driver licence issue date

Driver licence expiry date

Special conditions

Driver licence has been signed

Yes No

Date

Country of issue

I acknowledge that I have been provided with a copy of the University’s Motor Vehicle Policy, and have read and understood it, and agree to abide by the Policy. If the vehicle I am driving is not a University vehicle it must be privately insured, have a current WOF and be fit-for-purpose. If I am a student I may NOT drive other students unless I am specifically authorized to do so on this form.

I also acknowledge that any changes of circumstance related to the above details or my driving ability must and will be advised to my Manager immediately. I acknowledge that failure to do so may invalidate insurance cover and could result in disciplinary action. If an accident occurs and I am found to be negligent I may be asked to reimburse the UOA’s insurance excess.

NOTE: In addition to the University’s Motor Vehicle Policy there may be particular requirements determined by individual departments regarding vehicle usage. It is the Driver’s responsibility to ensure they locate these instructions and comply.

Driver's Manager:

Name of authoriser

Driver’s Licence has been sighted and approval has been given to the person named on this form to drive a vehicle on University business.

Authorised to transport students

Yes No