ࡱ> \^[ :bjbjVV D^<< &'''8_D'C:'Nuuuu:P}!Q$|uu:::Luu::::uo'd:0C:!:!:!:\::C! : Iowa Department of Administrative Services  Human Resources Enterprise Notice of Conviction for a Violation of a Motor Vehicle Law Driver s Name: FORMTEXT       FORMTEXT       FORMTEXT      LastFirstMiddleCurrent Home Address: FORMTEXT       FORMTEXT      City, State, Zip CodeDriver s License Number: FORMTEXT      Date of Birth: FORMTEXT        Commercial Driver s License Only State employees who are required, as a condition of ongoing employment, to have a Commercial Drivers License (CDL) must notify their employer of any motor vehicle law convictions (other than parking violations). Notification must be made not later than 30 calendar days after conviction. Provide the following information to your immediate supervisor if your job requires a commercial drivers license and you were convicted for a violation of a motor vehicle law. Type of Violation: FORMTEXT      Date of Violation: FORMTEXT       Enforcement agency that issued citation: (examples: City of Des Moines, Iowa State Patrol) FORMTEXT       Location of Violation: FORMTEXT       FORMTEXT      CityState Citation Number: FORMTEXT      Date of Conviction:* FORMTEXT       Was the violation in a commercial motor vehicle? Yes  FORMCHECKBOX  No  FORMCHECKBOX  * Conviction means judgment of guilty, guilty plea, or payment of fine. All Driver s Lic    0 2 F H J T V Z \ p r t ~ ¼pWEW#jth]`hL$CJU^J0jh]`h CJOJQJU^JmHnHu#jh]`hL$CJU^Jh]`h CJ^Jjh]`hL$CJU^Jh]`h5?CJ^Jh]`h;CJ^Jh;CJOJQJ h;CJ,h]`h;OJQJ^JaJh;5CJ\h]`h;OJQJ^JaJ,jhI5OJQJU\^JmHnHu^  0 X Z $$Ifa$gdy $$Ifa$$a$ ^  ^ $^a$j^j ^       * , 0 2 F H J T V X Z ޺ދy޺ދg޺\ދh]`h5?CJ^J#jxh]`hL$CJU^J#jh]`hL$CJU^Jh]`h CJ^Jh]`hyCJ^J hyh;h]`h;6CJ^JaJh;h]`h;CJ^J0jh]`h CJOJQJU^JmHnHujh]`hL$CJU^J#jh]`hL$CJU^J# aXOXOXO $$Ifa$ $$Ifa$kd\$$Ifֈ%= 44 ayt]`  . 0 X aXXXXX $$Ifa$kdH$$Ifֈ%= 44 ayt]`X Z \ ^ ` ~~~u $$Ifa$ $$Ifa$wkd$$If\%44 ayt]`  . ~~~~ $$Ifa$wkd$$If\%44 ayt]`       * , . 0 2 4 6 v x z ޺ޤ޺ndXL:"jhL$CJU^JmHnHuh]`h;5CJ^Jh]`h]`5CJ^Jh;CJOJQJ+jhL$hL$>*CJU^JmHnHuhJi}CJOJQJh;#jh]`hL$CJU^Jh]`h CJ^Jh]`hyCJ^Jh]`h;CJ^J0jh]`h CJOJQJU^JmHnHujh]`hL$CJU^J#j.h]`hL$CJU^J. 0 2 6 x 6^{rrrrr $$Ifa$$xa$$a$wkd$$If\$ %A  Q 44 ayt]` ! G H   2468LNPZ\^`.02귬귬oh귬V#jxh]`hL$CJU^J h]`h;#j<h]`hL$CJU^J0jh]`h CJOJQJU^JmHnHu#jh]`hL$CJU^Jh]`h CJ^Jjh]`hL$CJU^Jh]`h;5CJ^Jh]`h5?5CJ^Jh]`h]`5CJ^Jh]`h;CJ^Jh]`hyCJ^J!^`b@tofff $$Ifa$$a$kd$$IfrTg)%q_ 44 ayt]`2<>@Bnprt *,TVZ\pͻذذƀxذfͻذ#j h]`hL$CJU^Jh]`CJ^Jh]`h;6CJ^J#j h]`hL$CJU^J#jf h]`hL$CJU^Jh]`h CJ^Jh]`hyCJ^J h]`h;h]`h;CJ^Jjh]`hL$CJU^J0jh]`h CJOJQJU^JmHnHu'@BDr $$Ifa$gdy $$Ifa$$a$Qkd$$If0% 44 ayt]`{r{r $$Ifa$ $$Ifa$zkdR $$If4\%3 44 af4yt]`.0Zsjjjj $$Ifa$ $$Ifa$gd]`$a$zkd $$If4\%3 44 af4yt]`prt~&(DFHJL4 4 4455޺ި޺ި޺wlcWUWcWJh]`hyCJ^JUh]`h]`5CJ^JhJi}5CJ^Jh]`h;CJ^Jh]`h;CJ^JaJ#j h]`hL$CJU^J#jT h]`hL$CJU^Jh]`h CJ^J h]`h;h]`h;CJ^J0jh]`h CJOJQJU^JmHnHujh]`hL$CJU^J#j h]`hL$CJU^JJL^4779tooogo``ooo$xa$$a$gdy$a$kd $$Ifru<%W44 ayt]` enses: (Operator, Commercial, Chauffeur, etc.) State employees who are required, as a condition of ongoing employment, to have a driver s license of any kind must notify their employer when their driver s license is suspended, revoked, cancelled, or the driver is otherwise disqualified from operating a motor vehicle. Notification must be made before the end of the business day following the date the employee received notice of the loss of driving privileges. Provide the following information to your immediate supervisor if your driver s license was suspended, revoked, cancelled, or you were otherwise disqualified from operating a motor vehicle. Action: FORMTEXT      From: FORMTEXT       To: FORMTEXT      (suspended, revoked, cancelled, etc.)DateDate  Driver s SignatureDate:Supervisor s SignatureDate:     CFN 552-0563 R 02/2011 5557<8>899 9,90929F9H9J9T9V9f9h9|9~99999999999999ꝯrjX#j(h]`hL$CJU^Jh]`CJ^J#jh]`hL$CJU^J0jh]`hyCJOJQJU^JmHnHu#j<h]`hL$CJU^Jjh]`hL$CJU^JhJi}CJ^Jh]`h;5CJ^Jh]`hy5CJ^Jh]`h]`5CJ^Jh]`hyCJ^Jh]`h;CJ^J!9 909X9Z9f9999 $$Ifa$gdy $$Ifa$ $$Ifa$ $$Ifa$gdxs $$Ifa$gd]`$a$999::::NE<EE< $$Ifa$ $$Ifa$kd$$Ifl֞&<D%<v44 laytJi}99*:,:.:0:2:>:@:h:j:~::::::::::::::::::::޿hJi}CJOJQJh;CJOJQJhOxjhOxUh;CJOJQJ h]`h;h]`hyCJ^Jh]`h;CJ^J&jhL$CJU^JaJmHnHuh]`h;CJ^JaJh]`hy6CJ^JaJ h]`hy: :*:,:.:2:X:<77$a$kd$$Ifl֞&<D%<v44 laytJi} $$Ifa$ $$Ifa$X:Z:f:h:j:::::uwkd`$$Ifl\^D%6  44 laytJi} $$Ifa$ $$Ifa$:::::::::::::::~$a$wkd$$Ifl=\^D%6  44 laytJi}z&P+p,p-p.p/R 4567:p^"/ =!"#$% F$bvepJFIF``C    $.' ",#(7),01444'9=82<.342C  2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?( ( ( (l7)'?ΦnSK|5y?vйEV ( ( ( ( ( ( ( ( m>Qjq6>\VwY3wu5OyZ UsoZx!MQ_?[0,ldMyUvyQLD%2#>WGQE((((((*Hr[w8pX/g2Pҳatp&ʼnɹ7[[~KYV\tgӼ%`z ֔įf)?{o#Wþj[:kð5$>__O#QEfQEQEQEQEQEQEɿI=Fsoe#lud&8u xYP@lQ ڬ,1-EƆ>oEm.k6kBK,RF|׮kbLE ;Q]$Q@Q@Q@Q@Q@Q@k]nYC =0kuz2䌌duf™%9;yHPx 5YZ{K B]Ay0mD 汮<$ ,j0m2QоrpPm'iE qMI+H$yk2$W[qp~HhRv:\ڼJ*$?.א7Pp~_.X ޣ⚳D o+Knd.@s1ZxINug U2gi?7 We%Ş䕡:$dgkZX7ZܟkWÚ<YK5%.Akro&H$(P0'ּ.O~ޅyRǚUKɬqJy =uK<XOfHdSv"neO.z+/ kwV:–&J3)&p'Z{lDN$d2 [\zϗаxtl:FAU#θɈUk;DZc];D|wG|V7$$ִ#PM:R|Of忇(WEU?0㞽*fU! >K_'Es{R0`c$hww:֦246'Qj.?qw߁mI{WS ڷmD۲vz]ྰo# =Wko5vV['-1K 3b+xyЧ7v/2v(hotھhotڻrEO%2kZkooAj/O1Y&-Zwk j#RCGc_tJe# |,}++zIzW?7g{30\׿?v៳yՁ?(hQH !W_#i םZQFwW5S#FCrb=:E2m$fe XmQE¾rmgj6rmgj>ooAk寁S-o̿?F_ 6[˓7Ӌ[ 8Xg'3_ uk/5z;FT֤ k5|^gHkW Q#qC"7ctAe*˓RA^:+pj3 Nw~bR-">YhV% W|}uMz#?Qz?$Fj<. K"ʗ̅{xgRUMV>zg9bFՇPA5gu74UX! ?0k At|I&~\C:nǼWCYa\^ Qvz0,T8d #Zӵ/iKq?xu׋Ns٤ϕ߅^/w<[?嵡r?\tI $FGUXDŽ ~&Sҭn21Fν*yfv>1;y^)`pT⾶g'# ;/`u~' L%P9DÝk]͞>X3|[Ǡu+EWl #n^?;Wx-r]0洆x]So~גx_|g櫪h~l1yKy1])F숚mYW)7_R׃g<'/Qda0x]XW*@ռ6'WpW2V._G | \^!s,0O3_1cw*׭%acN~ZS[2Gxj[?IONiF0`'#=ݷRdx#pש?Jx"UK=K<\7>|G\ͩ1KwQT FMvZ85[cjz,r%KxH)2usI%JI[v)k?[UJ4YmSP=У及owFmaL19aG]~+ӵh؁&ş {ClھnK"dڹ=x5=$oz&P%{XώN`##" ࿍`5&/nxYs?Q^Z$vnis0@(1Q F|hb}r+ΧnhK^miD {K?'1N黐Z}׈#`ǝqz$ s[ԫ[.;]K?uU$|RwKWP}T9f?"5]L ĄtD A[UIQVK[h,tDText1tDText2tDText3$$If!vh5555= 55#v#v#v#v= #v#v:V ,5555= 55/ / / 4 yt]`$$If!vh5555= 55#v#v#v#v= #v#v:V 5555= 554 yt]`tDText4tDText5$$If!vh5555#v#v#v#v:V ,5555/ / 4 yt]`$$If!vh5555#v#v#v#v:V 55554 yt]`tDText6tDText7$$If!vh5A 5 5Q5 #vA #v #vQ#v :V ,5A 5 5Q5 / / 4 yt]`tDText8tDText9$$If!vh5q555_5 #vq#v#v#v_#v :V ,5q555_5 / / 4 yt]`vDText10v$$If!vh5 5#v #v:V ,5 5/ 4 yt]`vDText11vDText12$$If!vh53555 #v3#v#v#v :V 4,53555 / / 4 f4yt]`$$If!vh53555 #v3#v#v#v :V 453555 4 f4yt]`vDText13vDText14$$If!vh55555W#v#v#v#v#vW:V ,55555W/ / 4 yt]`tDeCheck1tDeCheck2vDText15vDText16vDText17$$If!vh5<55555v5#v<#v#v#v#v#vv#v:V l,5<55555v5/ / / ytJi}$$If!vh5<55555v5#v<#v#v#v#v#vv#v:V l5<55555v5ytJi}$$If!vh56 555 #v6 #v#v#v :V l,56 555 / ytJi}$$If!vh56 555 #v6 #v#v#v :V l=,56 555 / / ytJi}^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH D`D ^"NormalCJOJQJ_HmH sH tH J@J ^" Heading 1 $@&^p5CJOJQJ\N@N ^" Heading 2$x@&^5CJOJQJ\DA D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List JJ ^" Prerequisite:a$5CJOJQJ44 ^"Header !4 @4 ^"Footer !PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] / J %%%( 2p59: ! X . ^@99:X:::  "#$$*`lr>JPkw},<EUJV\eqw~/ FFFFFFFFFFFFFFG G FFF,R$$bvep|J# AA@(  6B   |6B   V6B   |  A?"DAS-HRE logoPicture 20DAS-HRE logo"B S  ?/ vHQtl%lt%ta%tText1Text2Text3Text4Text5Text6Text7Text8Text9Text10Text11Text12Text13Text14Check1Check2Text15Text16Text17a?l,EKf0  +sQ~=V]x0       - 0        # - 0 33y^"D)? 75?lZ]`jxsJi}IOx L$U; @L/ XX X@XXX4UnknownG* Times New Roman5Symbol3. * ArialA.Arial NarrowACambria Math"1h44WfYY!0  6HX? *!xx,552-0563 Notice of Conviction for ViolationSChurch2jpiersoOh+'0  0< \ h t 0552-0563 Notice of Conviction for Violation SChurch2Normaljpierso2Microsoft Office Word@F#@hW=+@@Y՜.+,0 hp  DAS-HRE  -552-0563 Notice of Conviction for Violation Title  !"#$%&'()*+,-./123456789;<=>?@ABCDEFGHIJLMNOPQRTUVWXYZ]Root Entry F?v_Data 01Table:!WordDocumentD^SummaryInformation(KDocumentSummaryInformation8SCompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q