Employee Driver Record Release

Employee Driver Record Release

Personal Information

Employee Name:

Date of Birth:    Last 4 of SSN:

Driver's License Information

License Number:    Issuing State:

License Class/Endorsements:    Expiration Date:

Commercial Driver's License (CDL): Yes

Position Information

Reporting Manager:    Anticipated Start Date:

Employment History (Most Recent)

Job Title:    From:    To:

Job Title:    From:    To:

Education

Graduation Date:

References

Legal Disclosures

At-Will Employment: I acknowledge that, unless I have a written agreement signed by an authorized company representative, my employment is on an at-will basis. Either I or the company may terminate my employment at any time, with or without cause or advance notice.

Equal Employment Opportunity: The company is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, or any other status protected by applicable law.

Driver Record Authorization and Release

I, the undersigned employee, authorize the company and its agents to obtain and review my Motor Vehicle Record (MVR) and driving and accident history from any local, state or federal agency, insurance company, or past employer as necessary to evaluate my driving qualifications. This authorization applies to initial pre-employment/placement checks, periodic checks during my employment, and checks following any accident or incident in which I am involved while operating a company vehicle.

Scope of Release: I authorize disclosure of any driving-related records, including but not limited to citations, suspensions, revocations, accident reports, and claims history. I expressly release all such agencies, prior employers, and the company from liability for furnishing this information to the company in accordance with this authorization.

Consent for Contact: I authorize the company to contact the previous employers listed on this form for the purpose of verifying my driving record, employment dates, positions held, and safety-related performance. I understand that falsification or omission of driving or employment history may disqualify me from employment or subject me to disciplinary action.

Check the types of driving record checks authorized:

Pre-employment / initial check    Periodic/annual check    Post-accident or incident check    Safety-sensitive assignment checks

Applicant Certification and Authorization

I certify that all information provided on this form is true and complete to the best of my knowledge. I understand that the company will rely on this information in determining my eligibility to operate company vehicles. I authorize the release of my driving history and relevant employment information and waive any claims against the company and the entities providing such information for damages arising from their release or use of this information as permitted by this authorization.

Background Checks: I authorize the company to obtain investigatory consumer reports and background checks, including motor vehicle records, criminal records, and other consumer information as permitted by law. I understand that adverse findings may affect my employment status.

Acknowledgment

By signing below I acknowledge that I have read and understand this Employee Driver Record Release, that I consent to the release and review of my driving records as described, and that I understand the consequences of providing false or incomplete information.

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