Vehicle Use Agreement and Consent to Obtain Driving Record(s)
Chapter 5 - Administration
for Guideline 220.127.116.11 Driver's License Record Check
Effective September 1, 2009
The information you are being asked to provide on this page will be used by Minnesota State Colleges and Universities to determine your eligibility to drive state owned or leased vehicles for system activities. This information will be submitted to the state Department of Motor Vehicles for each state where you have held a driver's license in the past five years. The driving record(s) obtained will be reviewed by the state Risk Management Division of the Department of Administration, which will rate the acceptability of your driving record. This rating will be maintained by the applicable system Human Resources Office and available to other system personnel including, but not limited to, your supervisor, who have a need to verify your eligibility to drive a state owned or leased vehicle. This consent form will be used to annually verify your driving eligibility unless you rescind your consent in accordance with the applicable campus or office procedure. You are not required by law to provide this information, but if you do not do so you will not be eligible to drive a state owned or leased vehicle. If your job responsibilities require that you drive a state owned or leased vehicle and you do not wish to complete this form, please discuss with your supervisor. Your ability to drive a personal vehicle for system activities is not affected by your completion of this page. If you have any questions about this form or policy, please discuss them with your supervisor.
Please return this form to the Human Resources Office. The submission and review process may take 7 to 10 working days. Effective 9/1/09, an employee's driving record must be acceptable before reserving a state owned or leased vehicle.
For your convenience, the form is available in two formats.
- Click here to download the form as a PDF. - The pdf can be printed and filled in manually before mailing back to the Human Resources Office.
- Click here to download the form as a Word document. - The word document may not be altered, however the document contains fillable boxes. You may also save a copy of the form for your records.