Vehicle Request Forms

Vehicle Request Forms
Which Vehicle Use Form are you looking to complete?*

Vehicle Use Acknowledgement FormTake-Home Vehicle Request FormVehicle Use Exception Request Form
Vehicle Use Acknowledgement Form
Employee & Vehicle Information
Full Name*

First NameLast Name
Department*
Job Title*
Driver's License Number*
County Vehicle ID (if assigned)
Policy Acknowledgement & Compliance
By checking the boxes below, you are agreeing to each of the following:*

I have received and read the Roane County Vehicle Use Policy.I understand that county vehicles are for official use only unless specifically authorized.I agree to follow all traffic laws and safety practices, including the prohibition on distracted orimpaired driving.I understand that smoking, vaping, and the use of any tobacco products are strictly prohibited incounty vehicles in accordance with Roane County policy and Tennessee state law.I will not allow unauthorized individuals to drive or ride in a county vehicle.I understand that commuting in a county vehicle may be considered a taxable fringe benefit and will be reported accordingly.I will report any incidents, damage, or citations involving county vehicles to my supervisor immediately.I agree to maintain the vehicle in a clean and secure condition and use it responsibly.
Signature*
Date*

MonthDayYear
Date
Take-Home Vehicle Request Form
Employee Information
Full Name*
Job Title*
Department*
Drivers License Number*
County Vehicle ID or Description*
Take-Home Vehicle Request Details
Reason for Request (e.g., On-Call Duty, Operational Need, etc.):*
Proposed Start Date*

MonthDayYear
Date
End Date (if temporary)*

MonthDayYear
Date
Home Address (for vehicle storage)*
Estimated Commute Distance (Round Trip in Miles)*
Employee Acknowledgement
By checking the boxes below, you are agreeing to each of the following:*

I understand that personal use of the take-home vehicle is limited to brief, incidental stops along my normal commute route.I understand that unauthorized passengers are not permitted in the vehicle.I agree to park the vehicle securely at my residence when not in use.I understand that commuting in a county vehicle may be considered a taxable fringe benefit and will be reported on my W-2.I will report any changes to my use, location, or role that may affect this assignment.I will comply with all applicable policies, including safe driving practices and prohibitions on smoking or tobacco use in county vehicles.
Approval Signatures
Signature*
Date*

MonthDayYear
Date
Vehicle Use Exception Request Form
Employee Information
Name*

First NameLast Name
Department*
Job Title*
County Vehicle Assigned*
Exception Request Details
Describe the nature of your exception request (transporting a non-employee):*
Reason for the request:*
Frequency or duration of this exception (e.g., daily, one-time, specific dates):*
Employee Acknowledgement
By checking the boxes below, you are agreeing to each of the following:*

I understand that County policy prohibits transporting non-employees in County vehicles unless prior written approval is granted.I understand that any approved exception does not remove my responsibility to operate the vehicle safely and in accordance with all County and state laws.I acknowledge that the County may revoke this exception at any time.
Approval Signatures
Employee Signature*
Date*

MonthDayYear
Date
Please note: Submitting this form does not guarantee approval. The information provided will be forwarded to your direct supervisor for review. You will be contacted once a decision has been made regarding approval or denial.
Should be Empty:

Vehicle Request Forms

Vehicle Use Acknowledgement Form

Employee & Vehicle Information

Policy Acknowledgement & Compliance

Take-Home Vehicle Request Form

Employee Information

Take-Home Vehicle Request Details

Employee Acknowledgement

Approval Signatures

Vehicle Use Exception Request Form

Employee Information

Exception Request Details

Employee Acknowledgement

Approval Signatures