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2. 

4. The City of Everett encourages employees to use alternative transportation methods such as biking, walking, carpooling, vanpooling or riding the bus to travel between home and work. The City of Everett offers financial incentives and other benefits to employees who use alternative methods three days a week or 60% of their commute time.

8. Fill out all applicable fields of this form. Incomplete forms will not be processed.
   
   

   For more information regarding the Smart MOVE Program, 
   contact your Employee Transportation Coordinator at x8803.

10. First Name*
11. Last Name
13. Employee #*
15. Address*
17. City*
18. State*
19. Zip*
21. Contact Phone*
23. Contact Email*
25. Department*
26. Payroll Account Number*
28. Supervisor Name*
29. Supervisor Phone*
31. Day Laborer?

    1. Yes
    2. No
32. If yes, Specify End Date
34. AmeriCorps Member?

    1. Yes
    2. No
35. If yes, Specify End Date

39. I rideshare at least 60% of my commute using the following mode:  (Choose only one option)

41. Methods of Rideshare*

    1. Carpool
    2. Walk

    1. Bicycle
    2. Ferry

    1. Vanpool
    2. Bus
43. Vanpool #
45. Bus (check all that apply)

    1. Community Transit
    2. Employee ORCA Passport
    3. Everett Transit

    1. King County Metro
    2. Skagit County
47. License Plate Numbers

    Please list the license plate numbers of all vehicles YOU drive and park in the carpool/vanpool parking areas. (DO not include your rideshare partners' vehicles)

49. Carpool Partners / Vanpool Leader

    List your carpool partners or your vanpool leader and their department. If not a city employee, list their company and contact phone number.

53. I certify that I use the above mode of transportation at least 3 days per week or 60% of my workdays each month. I understand that I am eligible for incentive as long as I meet the program conditions. Should any changes occur in my participation in this program, I will notify the ETC immediately. Fraudulent use of passes or benefits may result in disciplinary action up to and including termination as stated in “Code of Ethics and Employee rules and Regulations 3.1A”.

55. Electronic Signature*

    By typing your name above you acknowledge the requirements of the program conditions.

Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field