Notice to Employee of Point Assignment by the Department of Motor Vehicles

Instructions to department: After this notice has been signed by the employee, give a copy to the employee and retain the original for departmental files.

TO ___________________________________________________ (Employee)

FROM ________________________________________________ (Department manager)

DATE _________________________________

As you know, your job is included in the Department of Motor Vehicles Employer Pull Notice (EPN) program. This means the University, as your employer, receives notification from the DMV whenever you have been convicted of a moving vehicle violation (whether on and off the job) or have had any action taken against your driver's license, certificate, or permit.

This is official notice that the University has been notified by the DMV of the following action regarding your driving record:

Date Action Points
Cumulative Point Total
/12 Months
/24 Months
/36 Months

Information received through the EPN program may be used as a basis for disciplinary actions, up to and including dismissal. If the University determines that you have a poor driving record, or your DMV point total equals or exceeds that which the DMV considers to be "negligent," the University can no longer employ you as a driver.

Your driver's license, as well as any special driver certificates or permits necessary for your job, must be maintained in good standing. The loss of your driver's license or certificates, or a poor driving record, may result in termination of employment with the University.

I have received a copy of this information.

Employee's Signature __________________________ Date ______________