EMPLOYEE MOTOR VEHICLE PARKING PERMIT APPLICATION

LAST NAME:

FIRST:

HOME ADDRESS:

DEPARTMENT:

BUILDING:

FACULTY:_____ ADMINISTRATOR:____ SUPPORT STAFF:____ M.W. WOOD:_____

FULL TIME:____ PART TIME:____ WEEKENDS ONLY:____

NORMAL WORK HOURS:

STARTING DATE OF EMPLOYMENT:

IF NEW EMPLOYEE, NAME OF PERSON YOU ARE REPLACING:

PLEASE RANK VEHICLES BY FREQUENCY OF USE:

1. LICENSE PLATE:

STATE:

COLOR:

MAKE/MODEL:

YEAR:

TYPE:

2. LICENSE PLATE:

STATE:

COLOR:

MAKE/MODEL:

YEAR:

TYPE:

3. LICENSE PLATE:

STATE:

COLOR:

MAKE/MODEL:

YEAR:

TYPE:

4. LICENSE PLATE:

STATE:

COLOR:

MAKE/MODEL:

YEAR:

TYPE:

In applying for a campus parking assignment, I hold Lafayette College free of all liability for damage to my motor vehicle except that caused by Lafayette College equipment under the control of Lafayette College, its agents or employees.
I agree to abide by the "Lafayette College Motor Vehicle and Traffic Regulations" for employees.

SIGNATURE: _________________________________________ DATE:

PLEASE RETURN COMPLETED APPLICATION TO: OFFICE OF SECURITY AND SAFETY ROOM 11, MARQUIS HALL

FOR OFFICIAL USE ONLY:

LOT ASSIGNMENT:

1. STICKER #:

DATE:

INITIALS:

2. STICKER #:

DATE:

INITIALS:

3. STICKER #:

DATE:

INITIALS:

4. STICKER #:

DATE:

INITIALS:

REV: PARKING\EMVPPA\05/96