Employee-Fleet Driver Exclusion Template
Employer Information
Company Name
Address
Contact Person
Phone Number
Excluded Employee/Driver Information
Full Name
Position/Title
Driver's License Number
Exclusion Details
Effective Date
Reason for Exclusion
Vehicles Covered by Exclusion
Vehicle Make/Model
Year
License Plate
VIN
Acknowledgement
Additional Comments/Notes
Authorized Employer Signature
Date
Excluded Employee/Driver Signature
Date