MVR Form

YOUNGSTOWN STATE UNIVERSITY MOTOR VEHICLE RECORD STATEMENT

Youngstown State University requires that all drivers of university-owned, rented or leased vehicles complete this form, prior to driving a vehicle, so that a Motor Vehicle Record (MVR) check can be performed.

Any combination of accidents or citations that total six or more points in the last three years, as assigned below, may result in a decision by the University not to allow a driver to operate a university-owned vehicle, rented or leased vehicle.

6 points

Driving under the influence of drugs or alcohol

Using a motor vehicle to commit a felony or committing any crime deemed a felony

Vehicular homicide/involuntary manslaughter

Hit skip/leave scene

Driving under suspension/revocation

Drag racing

Flee/elude police officer

Negligent entrustment of a vehicle

Driving without owner consent

4 points

Driving without due regard for safety

Unsafe or reckless operation

Speeding over the limit by 30 MPH or more

2 points

Traffic control device/stop sign

Assured clear distance/following too close

Failure to yield/failure to control

Improper passing/driving left of center

Other violations as assigned by the ORC

Speeding over the limit by 10 MPH when the posted limit is 55 MPH or more

Speeding over the limit by 5 MPH when the posted limit is less than 55 MPH

Permission Statement

By filing out the form below, I acknowledge the above disclosure and give permission to Youngstown State University to obtain a copy of my driving record to verify it meets the criteria established by the University to drive and this information may be shared for this purpose with appropriate individuals. This permission may be used to check my driving record at future dates for this purpose unless I revoke this permission statement in writing. In the event my driver’s license is revoked or suspended, I agree to immediately discontinue operation of the University vehicle and notify my supervisor. I acknowledge the University requires compliance with all applicable state motor vehicle regulations relating to driver responsibility, including seat belt use.

Name *

Date

Year

Month

Day

YSU Email Address *

YSU Department *

Birthday *

Year

Month

Day

Phone Number *

Supervisor's Name *

Classification *

Student

Faculty/Staff

Graduate Student

Non-Univerity

Will you be driving a large van *

Yes

Will you only be driving a golf cart *

Yes

Driver License Number *

State of issued license *

Signature *

By typing in your name, you are stating that you will adhere to all YSU rules and policies in regards to motor vehicles.

Leave this field blank