PUBLIC SAFETY VAN AND MOTOR VEHICLE RECORD AUTHORIZATION/RELEASE


  • I understand that Students, faculty and staff wishing to drive a University van must complete a motor vehicle record background check.
  • I understand that Drivers of University owned vehicles must be a current employee or student. Family members, former employees, alums, etc. are not permitted to drive University vehicles.
  • I understand that completion of the driver orientation program is required prior to driving a University van.
  • I understand that Maryville University employees and students are prohibited from using any handheld electronic device while operating a University vehicle.
  • I understand that all Maryville vans are limited to 10 people including the driver.
  • I understand that a bus company will be used for transportation needs for out of town trips for athletic teams, student activities and field trips requiring the use of more than two vans.
  • I understand that drivers younger than 19 will NOT be permitted to drive a University van unless a Maryville employee not younger than 21 is present.
  • I understand that driving time is limited to 4 hours before a rest break must be taken.
  • I understand that a backup driver is required on all trips over 6 hours each way.
  • I understand that a Maryville employee is required to be present on all out of town and/or overnight trips. (Out of town is defined as any trip in excess of 100 miles from the main campus.)
  • I understand that Maryville University does not permit the rental of 15 passenger vans for University related activities/events.
  • I understand the use of a trailer hitch is not permitted on any University van being used to transport passengers.
  • I understand that failure to return van keys and/or gas credit cards, and/or return a dirty van will result in a $50 fine to the group/department that reserved the van.
  • I understand that Maryville University does not permit the use of University vans for non University related activities/events.
  • I understand that as directed by University policy you may be requesting information from public and private sources about my driving record. I voluntarily and knowingly authorize the University and/or its agents, to verify any aspect of information regarding my driving record through public and private records.
  • I voluntarily and knowingly authorize any former employer, person, or government agency, its officers, employees and agents to release any and all information concerning my driving record to you or your agents.
  • I voluntarily and knowingly, fully release and discharge, absolve, indemnify and hold harmless you, your agents and any former employer, person, firm, corporation, or government agency, its officers, employees and agents from any and all claims, liability, demands, causes of action, damages, or costs, including attorney’s fees, present or future, whether known or unknown, anticipated or unanticipated, arising from or incident to the disclosure or release of any such information to you, your agents, or consumer reporting agency.
 

VAN AND MOTOR VEHICLE RECORD AUTHORIZATION/RELEASE FORM

  • MM slash DD slash YYYY
  • If you have not watched the van safety video, please contact the Public Safety Office for the link to the video.
  • This field is for validation purposes and should be left unchanged.