Employee Driver Authorization

EMPLOYEE DRIVER AUTHORIZATION

Employee Information

Employee Name:

Phone:     Email:

Date of Birth:     Employee ID (if applicable):

Position & Employment Details

Reporting Manager:     Start Date:

Driver License & Driving Record

Driver's License Number:     Issuing State:

License Class:     Endorsements:     Expiration Date:

I have had a license suspension, revocation, or disqualification within the past five (5) years:

Authorization & Consent

By signing below, I certify that the information provided on this form is true and complete. I authorize the employer to obtain and review my motor vehicle records (MVR), driving history, and other records, and to conduct any periodic driving record checks necessary to determine my continued eligibility to operate company-owned or personal vehicles for business purposes. I further authorize prior employers, licensing authorities, and insurance carriers to release driving and claims information to the employer.

I understand that this authorization is a condition of employment for any position that requires driving, and that failure to notify the employer of any change in license status (suspension, revocation, or other restriction) or conviction for a driving-related offense may result in disciplinary action, up to and including termination. I release the employer and its agents from liability for damages arising from the employer's use of such records in accordance with applicable law.

Insurance & Accident Reporting

I acknowledge that while operating a personal vehicle for company business, I must maintain valid automobile insurance as required by law and company policy. I agree to notify the employer immediately of any accident, citation, or claim that occurs while on company business. I understand that I may be financially responsible for losses resulting from my failure to comply with company policies or applicable law.

Authorized Vehicle Types

The employee is authorized to operate the following company vehicle types (check all that apply):

Passenger automobile     Light truck/van

Box truck     Commercial vehicle (CDL required)     Other (specify)

Training & Safety

I agree to complete any required defensive driving or vehicle-specific safety training prior to operating a company vehicle. I will comply with all company vehicle policies, seatbelt requirements, cell phone and distracted driving policies, and incident reporting procedures. Noncompliance may result in revocation of driving privileges and/or disciplinary action.

Employment History

Previous Employer 1

Previous Employer 2

Education

Professional References

Reference 1

Reference 2

Reference 3

Legal Disclosures

At-Will Employment: The employee acknowledges that, unless otherwise provided in a written agreement signed by an authorized representative of the employer, employment is at-will and may be terminated by either the employer or the employee at any time, for any lawful reason.

Equal Employment Opportunity: The employer provides equal employment opportunity to all employees and applicants without regard to protected characteristics, in accordance with applicable law.

Certification & Release

I certify under penalty of perjury that the information contained on this form is true and complete to the best of my knowledge. I understand that falsification, omission, or misrepresentation of information is grounds for denial of driving privileges or for disciplinary action, up to and including termination of employment.

I authorize all persons, schools, current and former employers, insurance companies, and governmental agencies to release to the employer any information requested in connection with this authorization. I hereby release those entities from any liability for furnishing such information and release the employer from liability for its use and disclosure of such information consistent with applicable law.

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