Form Dr 500 025 PDF Details

Navigating the complexities of adhering to legal requirements while ensuring uninterrupted employment can be challenging, particularly for those mandated to install an ignition interlock device (IID) in their vehicles. The DR 500 025 form serves as a crucial document in this context, offering a structured pathway for employees who find themselves in need of driving an employer's vehicle — which does not have an IID installed — as part of their job responsibilities. The form stipulates clear eligibility criteria, primarily that an IID must be installed in the employee's personal vehicle. It delineates a straightforward process requiring the completion and endorsement of the form by both the employee and the employer, alongside the mandate to carry a copy of the form when driving for work purposes. The requirement to mail, email, or fax the completed form to the Department of Licensing further exemplifies the formal steps needed to secure this exemption. Importantly, the exemption applies specifically to vehicles driven during working hours and excludes employer vehicles assigned exclusively for commuting. In furnishing employees and employers with a formal process to apply for an Ignition Interlock Exemption, the DR 500 025 form plays a pivotal role in balancing the enforcement of DUI laws with the practicalities of employment that necessitates driving employer-owned vehicles.

QuestionAnswer
Form NameForm Dr 500 025
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesform employer declaration form, declaration ignition interlock form, dr 500 declaration device, wa dr declaration form

Form Preview Example

IIDILW

Employer Declaration for

Ignition Interlock Exemption

Use this form if you are required to have an ignition interlock device (IID) installed in all vehicles you drive AND your employer requires you to drive a vehicle without an IID.

Eligibility

To get an employer exemption, you must have an IID installed in your personal vehicle.

Exemption

If you have an IID installed in your personal vehicle and your employer requires you to drive a vehicle without an IID during working hours that is owned, leased, rented, or the temporary responsibility of your employer, you must:

•฀ Complete฀the฀employee฀section฀of฀this฀form

•฀ Have฀your฀employer฀complete฀and฀sign฀the฀employer฀section

•฀ Carry฀a฀copy฀of฀this฀form฀when฀driving฀for฀your฀employer

•฀ Send฀this฀completed฀form฀to:

Mail: Restricted Licensing

Department of Licensing

PO Box 9030

Olympia, WA 98507

Email: interlock@dol.wa.gov

Fax: 360-570-7824

You may only drive the vehicle(s) during working hours. Employer vehicles assigned exclusively to you that are used solely for commuting to and from employment are not eligible for an exemption.

Employee

PRINT OR TYPE Name of employee (Last, First, Middle initial)

 

 

Washington driver license number

Date of birth

(Area code) Daytime telephone number

Employer

Name฀of฀employer฀contact฀or฀representative฀

(Area฀code)฀Company฀telephone฀number

 

 

 

Company฀name฀

UBI฀number

 

 

 

 

Company฀street฀address

 

 

 

 

 

City฀

State฀

ZIP฀code

 

 

 

This employee is required to operate a vehicle during working hours that is owned, leased, rented, or in the temporary care of this company.

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

 

 

X

Date and place signed

 

Employer signature

DR-500-025 (R/7/16)WA

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