USDA Motor Vehicle Authorization Form

Submit the completed USDA Motor Vehicle Authorization Form to your HR department or designated supervisor. Ensure all required fields are accurately filled out and that both the employee/operator and supervisor have signed and dated the form. You can submit the form via email, fax, or physical delivery. For email submissions, use the designated HR email address provided by your organization. For fax submissions, use the provided fax number. For physical submissions, deliver the form to the designated HR office or supervisor's office. Follow up to confirm receipt and approval of your authorization.

The USDA Motor Vehicle Authorization Form should be renewed annually. Ensure to update your information for 2024 and 2025 as needed.

The USDA Motor Vehicle Authorization Form is designed to grant authorization to employees for using motor vehicles assigned to their work location. This form ensures that only physically fit and legally licensed operators are allowed to drive, thereby maintaining safety standards. Supervisors use this form to certify their employees' driving skills and keep a record of authorized vehicle operators.

• 1. NAME OF EMPLOYEE/OPERATOR: The full name of the employee or operator requesting vehicle authorization.
• 2. EMPLOYEE/OPERATOR PHYSICALLY FIT TO OPERATE VEHICLE: Confirmation whether the employee/operator is physically fit to operate the vehicle (Yes/No).
• 3. LICENSE NUMBER: The license number of the employee/operator.
• 4. STATE ISSUING LICENCE: The state that issued the license of the employee/operator.
• 5. EXPIRATION DATE: The expiration date of the employee/operator's license.
• 6. LICENSE CLASS: The class of the license held by the employee/operator.
• 7. RESTRICTIONS: Any restrictions associated with the employee/operator's license.
• 8. VEHICLE ACCIDENTS IN THE LAST 5 YEARS: Details of any vehicle accidents involving the employee/operator in the last 5 years.
• 9. SUSPENSIONS OR REVOCATIONS IN THE LAST 5 YEARS: Details of any license suspensions or revocations in the last 5 years.
• 10. AUTO RELATED ARRESTS, SUMMONS, SPEEDING TICKETS, AND CONVICTIONS: Details of any auto-related arrests, summons, speeding tickets, and convictions in the last 5 years.
• 11. EMPLOYEE/OPERATOR FULL NAME: The full name of the employee/operator for the certification section.
• 12. EMPLOYEE/OPERATOR SIGNATURE: The signature of the employee/operator certifying the provided information.
• 13. DATE: The date when the employee/operator signed the form.
• 14. SUPERVISOR FULL NAME: The full name of the supervisor certifying the form.
• 15. SUPERVISOR SIGNATURE: The signature of the supervisor certifying the provided information.
• 16. DATE: The date when the supervisor signed the form.

Failure to submit the USDA Motor Vehicle Authorization Form can result in the employee/operator losing authorization to use assigned motor vehicles. This can impact the employee/operator's ability to perform job-related tasks effectively.

• Loss of Vehicle Access: Employees/operators may be barred from using work-assigned motor vehicles.
• Job Performance Impact: Inability to use motor vehicles may affect the ability to complete job-related tasks.
• Compliance Issues: Failure to submit the form may result in non-compliance with regulatory requirements.

• 1. Request Authorization: To request authorization to use work-assigned motor vehicles.
• 2. Supervisor Certification: For supervisors to certify their employees/operators' driving skills.
• 3. HR Records: To maintain records of authorized vehicle operators in the HR department.
• 4. Compliance: Ensuring adherence to regulatory driving requirements.
• 5. Fleet Management: To oversee vehicle assignments and usage.