UCLA

Instructions : After the employee signs this notice, departments provide the employee with a copy and retain the original for departmental files.

TO: ___________________________________________________(Employee)

FROM: ________________________________________________(Department Head)

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 notices from the DMV whenever you have been convicted of any moving vehicle violation (both 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:

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:______________

cc:   Employee
        Personnel File
        DMV Pull Notice Liaison