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:


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