Permits may be issued to part-time and full-time EPA or SPA employees and Temporary employees. Individuals registered as a student at the University or working in a temporary, hourly position, such as graduate teaching assistants and research assistants are considered students. Please cooperate by not issuing authorization forms to students.
Please note: This form should be completed and signed by the employee's supervisor. The new employee should present this completed form at the Customer Service area, located in Administrative Services I on Sullivan Drive. (You will need to bring your license plate number, make, and year of vehicle).
Employee Name: |
9 Digit ID#: |
Date Assignment Begins: |
Date Assignment Ends: |
Departmental Box #: |
Telephone #: |
Check Distribution Code: |
|
The above named permanent employee is authorized to select payroll deduction.
YES |
NO |
* Temporary employees are not eligible for payroll deduction. Permits can be purchased on a daily, weekly or monthly basis.
Authorized Signature: ___________________________________ Date: ____________
Title: ___________________________________