Name:
ARKANSAS STATE VEHICLE SAFETY PROGRAM
September 2017
VSP-1 AUTHORIZATION TO OPERATE STATE VEHICLES AND PRIVATE VEHICLES ON STATE BUSINESS
The following must be completed and signed before authorization to drive on state business is given:
Agency Code/Name: 125/Arkansas State University
All Fields are Required:
Select type of individual:
Employee Student Employee Student/Non-Employee Non-Student/Non-Employee
ASU ID:
Email: Date of Birth: Drivers License Number:
Dept: Dept Phone: Dept Contact:
Check Each of the Following:
I understand that as permitted by Arkansas Code Ann. §27-50-906 (6)(A), the Office of Driver Services will notify
my employer each time a new violation is added to my driving record. I also understand that my employer has
access to my driving record through the SVS System (State of Arkansas Website) through Information Network of
Arkansas.
I understand that because of my driving record I may not be permitted to drive on State business.
I will participate in all required Defensive Driving Classes.
I will report all accidents and incidents that occur on state business to my employer and to BancorpSouth at
501-664-9252 immediately.
I have read the Driving Safety Tips Handout provided by my employer.
I understand that I must maintain liability coverage, as required by State Law, on my personal vehicles that I drive on State
business.
You are hereby authorized to obtain my Traffic Violation Record from the Office of Driver Services as permitted by
Arkansas Code Ann. §27-50-906 and §27-50-908. This record shall include material normally excluded by Arkansas Code
Ann. §27-50-802.
Signature of individuals appearing below shall constitute consent for the release of such records to the State agency named on this
form.
**STUDENT DRIVERS - I have attached a memo from the Vice Chancellor approving this student to drive.
*Attach copy of driver's license.
**According to Vehicle Safety Policy 04-24, student drivers must have approval from the appropriate vice chancellor to drive
ASU vehicles. Please include a memo with the proper signature if the driver is a student.
Driver's Signature: Date:
State
Select type of vehicle to be driven:
Private Both State and Private
State:
Supervisor's Signature: Date:
Last 4 Digits of SSN:
Contact Email:
Golf Cart
Other Equipment:
I pledge to end distracted driving, including but not limited to, use of a "handheld wireless telephone" while operating a
motor vehicle, in accordance with A.C.A §27-51-1504.
ARKANSAS STATE VEHICLE SAFETY PROGRAM
September 2017
VSP-2 AUTHORIZATION TO OBTAIN TRAFFIC VIOLATION RECORD
FROM DEPARTMENT OF FINANCE AND ADMINISTRATION,
OFFICE OF DRIVER SERVICES
Agency Code/Name: 125/Arkansas State University
Agency Address: PO Box 2100, State University, AR 72467
Physical Address: Administration Building, RM 104B, 2105 Aggie Road, Jonesboro, AR 72401
Agency Contact Person: Sandra Bramblett
Email Address: [email protected]
Telephone Number: (870) 972-2817
You are hereby authorized to obtain my Traffic Violation Record from the Office of Driver Services as permitted by
Arkansas Code Ann. §27-50-906 and §27-50-908. This record shall include material normally excluded by Arkansas Code
Ann. §27-50-802.
Signature of individuals appearing below shall constitute consent for the release of such records to the State agency
named on this form.
Driver's Signature: Date:
Name: ASU ID: Email:
Date of Birth: Drivers License Number: State:
*Attach copy of driver's license.
**According to Vehicle Safety Policy 04-24, student drivers must have approval from the appropriate vice chancellor to drive
ASU vehicles. Please include a memo with the proper signature if the driver is a student.
Form Submission Instructions:
Personal Delivery to Sandra Bramblett, Administration Building, RM 104B
Fax to 870-972-3975
Share Space: https://www.astate.edu/a/banner-support/training/sharespace/
Please do NOT send via email.
Supervisor's Signature: Date:
Form revised 01/07/2022
ARKANSAS STATE VEHICLE SAFETY PROGRAM
September 2017
DRIVING SAFETY TIPS
∇ Observe Speed Limits and Traffic Laws - Allow sufficient time to reach your destination without violating speed
limits or traffic laws.
∇ Seat Belts - Each driver and all passengers in any motor vehicle operated on State official business are required by
law to wear a properly adjusted and fastened seat belt. Statute: 27-37-702
∇ Cellular Devices - The use of cellular phones by the driver while the vehicle is in motion is "not allowed". A.C.A.
27-51-1504. This includes "hands free” equipment and smart watches. Communicating on the phone takes your
attention away from driving, making you less likely to notice hazardous situations.
∇ Backing Crashes - Most backing accidents are preventable. Whenever possible, park your vehicle where backing is
not required. Know what is beside and behind your vehicle before you begin to back. Back slowly and check both
sides as well as the rear as you back. Continue to look to the rear until the vehicle has come to a complete stop.
∇ Intersection Crashes - When approaching and entering intersections, be prepared to avoid crashes that other
drivers may cause. Take precautions to allow for the lack of skill or improper driving habits of other drivers.
Potentially dangerous acts include, but not limited to, speeding, improper turn movements, and failure to yield the
right of way.
∇ Weather Related Crashes - Rain, snow, fog, sleet or icy pavement increase the hazards of driving. Slow down and
be especially alert when driving in adverse conditions. Discontinue use of cruise control in wet or icy road
conditions.
∇ Passing Crashes - When you pass another vehicle, look in all directions, check your blind spots, and use your
signal. As a general rule, only pass one vehicle at a time.
∇ Rear End Crashes - The driver can prevent rear-end collisions in spite of abrupt or unexpected stops of the vehicle
ahead by maintaining a safe following distance at all times. Most crashes can be avoided by maintaining the "four
second rule" and following the vehicle ahead at a distance that spans at least four seconds. The following distance
should be increased when driving in adverse conditions.
∇ Security - State vehicles shall be locked whenever they are unoccupied.
∇ Engines - The engine of a State vehicle shall always be turned off before the driver exits the vehicle.
