Domicile to Duty Travel Form
Arizona Department of Administration - Risk Management
Email address *
Vehicle domiciling requirements:
-Personal use of the vehicle is prohibited.
-Use of the State Vehicle is for travel between your domicile address and your office/worksite; between your domicile address for after-hours responses; or from office/worksite for authorized responses.
-You must inform your supervisor of domicile address changes within 14 days.
-Vehicle must be parked in a secure area and locked. When parked at domicile address, State owned equipment such as portable radios, laptop/tablets, cellular phones, G.P.S. units, and gear packs must be removed and kept inside the domicile address.
-If you are going on extended annual leave or have other situations where your vehicle is not being utilized for after-hours responses, it shall be returned to the Agency Fleet parking area.
-Maintain a vehicle travel log for review as required by the Agency Fleet.
Name of Agency *
Your answer
Provide justification for this authorization request (for example, describe how this authorization will benefit the State by increasing employee performance, provide efficient service, promote savings and efficient time management, etc.): *
Your answer
Name *
Your answer
Your answer
Drivers License Number *
Your answer
Assigned Position *
Your answer
Domicile Address *
Your answer
Phone # *
Your answer
Directors Email Address *
Your answer
Never submit passwords through Google Forms.
This form was created inside of State of Arizona.