Get Carpool Certification (pdf) - State Of Oregon

Filling out the Carpool Certification form for the State of Oregon is an essential process for those participating in carpools. This guide will provide you with clear, step-by-step instructions to ensure that your form is completed accurately and efficiently.

Follow the steps to successfully complete your Carpool Certification form.

1. Click ‘Get Form’ button to obtain the Carpool Certification form and open it in your preferred document viewer.
2. Begin by entering your primary information: Provide your full name, employee ID or the last four digits of your Social Security number if you are a non-state employee. Fill in the agency, division, section, or unit, along with the agency ID, physical work address, work phone number, extension, and email.
3. Next, provide your primary vehicle identification information. List the make, model, year, state, and plate number for up to three vehicles you may use for carpooling.
4. In this section, confirm your commitment to carpooling by checking the box that indicates you carpool at least two-thirds of the working days each calendar month. Ensure you agree to the administrative rules outlined in OAR 125-090, specifically rule 125-090-0030, by marking the appropriate box.
5. Acknowledge that you cannot be registered in another carpool or Smart Commuter Program, nor can you lease a monthly parking space or permit concurrently, by checking the relevant box.
6. Complete the signature section by signing and dating the form to verify the information provided. If there are riders, repeat the process of entering their information, including name, employee ID, agency details, and vehicle identification for each additional rider.
7. Finally, review the completed form for any errors. Once verified, you may save your changes, download the form, print it, or share it as needed. Return the completed form via email, fax, or postal mail to the designated contact.

Ensure your participation in the carpool program by completing your Carpool Certification form online today!