Version 1.8  

Personal Car Form(For Local Travel ONLY)

New York City Department of Education

REQUEST FOR USE OF PRIVATE VEHICLE

Note: Permission to use private vehicle should only be granted when alternative means of transportation are not practicable. Permission should not be granted because it is the employee preferred means of transportation or for convenience.
Employee Reference Number:  Click here if you must search for your Employee Reference Number. A new screen will open allowing you to do a search. 
I, (full name), request permission to use my
personal automobile (see below) for official Department of Education business
Reason for Request: per the following dates:

 Start Date: StartDate
End Date:    EndDate

Note: Not to exceed 31 days. If over 31 days, a new form must be completed.

Personal Vehicle Information
Name of Manufacturer:
Model:
Year:
Color:
VIN #:
Plate #:
State of Registration:
My Driver’s License Number:
I Certify to the Following:
a) I am the registered owner of the vehicle or have been authorized by the registered owner to operate the vehicle and use it to conduct DOE business.
b) My driver’s license is not suspended
c) I have not have any of the following violations within ONE (1) year from date of this application:
         * DUI - Driving Under the Influence
         * DWI - Driving While Intoxicated
         * DWAI - Driving While Ability Impaired (or similar violation if licensed outside NYS)
d) Minimum auto insurance is in effect on the vehicle to be used for official DOE business.
e) Vehicle inspection is current on the vehicle to be used for official DOE business.
f) I will maintain a daily log indicating the mileage and points of departure and destination.
User Email Address:        @schools.nyc.gov  
Approver Email Address: @schools.nyc.gov