Employee Application

Please complete all information.

Employee Classification (*)

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First Name (*)

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Middle Initial

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Last Name (*)

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Employee ID

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Blazer ID (*)

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Department (*)

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Job Title (*)

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Employment Status (*)

Please select one option.
Handicap Permit Needed?

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If yes, Alabama handicap placard/tag number?

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Facility or Facilities Requested (*)

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Email Address (*)

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Campus Phone Number (*)

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Campus Address (*)

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Home Phone Number (*)

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Home Address (*)

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Primary vehicle you will be driving to campus.

Vehicle Year (*)

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Vehicle Make (*)

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Vehicle Model (*)

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Vehicle Color (*)

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License Plate Number (*)

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Vehicle Style (*)

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License State (*)

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Do you want to pick up the permit, or have it mailed to you? (*)

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By submitting this form, I am confirming that I have read and understand the rules and regulations under "Policy". I agree to abide by these regulations while operating and/or parking a motor vehicle on the UAB campus. I understand that parking citations which are unpaid or are not appealed to the Appeals Panel by the date indicated on the citation are delinquent. I understand that the amount of the fine and a late payment fee will be payroll deducted. I understand Parking and Transportation Services will make every effort to deduct my parking fee from my payroll check using my employee ID. However, if this deduction cannot be made, I authorize the department to payroll deduct any outstanding amount due once the deduction can be established.

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All fields marked with (*) are required.