COMPANY NAME

Take Home Vehicle Policy

I__________________________ understand that I have been approved for the privilege 
	PRINT NAME
of using vehicle number _________________to drive to and from work.  I understand that this vehicle is to be driven only by me and to be used exclusively for company related business.  I agree that I will not use this vehicle for personal reasons.
  
I understand that under no circumstances will I use this vehicle if my ability to drive has been impaired in any way.  This includes being under the influence of drugs (including prescription drugs), alcohol, illness or any other condition that could impair my ability to drive safely.

I further agree that I will maintain my legal ability to operate a vehicle in the state of XXXXXXXXX as well as my insurability.  

I understand it is my responsibility to notify, within 24 hours, the Fleet Manager of any change in my ability to drive, to remain insurable or of any traffic citations that I receive. 

In the event of any vehicle related accident involving damages or injuries, I agree to submit to a drug test.

Failure to abide by the above policies is cause for immediate termination of employment.




I agree to the above requirements and wish to have this privilege.

Signature____________________________________ Date________________

The vehicle identified above is parked at the following address after work hours.

________________________________________________________________


OR


I do Not agree to the above requirements and do not wish to have this privilege.

Signature____________________________________ Date________________