STAFF PARKING & VEHICLE DETAILS

Employees who wish to park their cars at Joondalup Health Campus must have a permit to park on-site. Staff should apply for an annual permit to park on-site using this application form. Application forms must be authorised by your manager or head of department or the permit will not be issued. There are a limited number of car parking bays at Joondalup Health Campus. Staff are only permitted to park in designated staff car parking areas. Staff are not permitted to park in the visitors car parks. If you have any queries or require any further information regarding the completion of this Application Form, please contact Debra Hughes (Redevelopment Project Officer) on extension 9760. PLEASE NOTE: Parking permits will be sent out to staff via JHC internal mail. Please ensure your personal details are correct or you may not receive your parking permit.
PLEASE COMPLETE THIS FORM USING CAPITAL LETTERS. ALL SECTIONS SHOULD BE COMPLETED. BOXES SHOULD BE MARKED WITH AN X.

Title First Name Surname Position Title Department Organisation Work Location Work Contact No.

Mr

Mrs

Ms

Dr

Other (please specify)

MAKE OF VEHICLE

MODEL

COLOUR

REG No.

OFFICE USE ONLY Permit No.

Are you an existing permit holder?

Yes

No

If Yes, what permit colour?

OFFICE USE ONLY Registered on Computer ___ / ___ / ___ Initial:

I:\Clinical Governance Unit\Quality\Templates\Forms\Staff Parking & Vehicle Details Form.doc

DECLARATION
I have read the above and agree to abide by the conditions as set out by Joondalup Health Campus. The issue of the permit is for the provision of parking and I understand that parking may not from time to time be available to me. Loss or replacement of the parking permit (when permit not returned) will incur a $20 administration fee. I have read the above and agree to abide by the conditions as set out by Joondalup Health Campus. I agree to inform the Redevelopment Project Officer of any changes to the information provided on this form. I understand that failure to inform the Redevelopment Project Officer of this may result in the revoking of the permit. I understand that the parking permit and/or access control card issued to me remains the property of Joondalup Health Campus. It is not transferable and will be returned to your manager/head of department on leaving Joondalup Health Campus. I hereby undertake to clearly display the issued permit on the windscreen of the vehicle parking at Joondalup Health Campus and that the permit does not guarantee a parking bay. I understand that Joondalup Health Campus reserves the right to withdraw my permit or change my allocated parking area. I understand that the information provided on this form will be subject to validation by my manager/Head of Department.

PARKING PERMIT Important information when attaching your parking permit! Your parking permit MUST be placed to the inside of your vehicles windscreen, on the DRIVERS LOWER side. Failure to correctly display your permit may incur an infringement notice.

I ..acknowledge that the safe keeping of the vehicle is my responsibility and that the vehicle is parked on private property at the vehicle owners risk. Joondalup Health Campus accepts no responsibility for loss or damage of any property or to any goods carried therein which is caused by the negligence or any manner whatsoever. I accept that I will park appropriately in the correct designated colour coded car park area and accept that failure to do so may result in a parking fine being incurred and/or my parking privileges revoked.

Applicants signature

Date

Signature of Head of Department/Manager

Date

Printed Name of Head of Department/Manager

Ratified by JHC Parking Committee May 2010

Position Title

I:\Clinical Governance Unit\Quality\Templates\Forms\Staff Parking & Vehicle Details Form.doc