Employee Driving Licence Mandate

EMPLOYEE DRIVING LICENCE MANDATE

Personal Information

Employee Name:

Phone:    Email:

Position and Employment Details

Reporting Manager:    Proposed Start Date:

Driving Licence Information

Issuing Jurisdiction (State/Province):

Licence Number:    Class/Type:    Endorsements:

Date of First Issue:    Expiry Date:

I certify that I have never had a driver's licence suspended, revoked, cancelled, or disqualified. If this is not true, provide details below.

Vehicle Operation Authorization & Insurance

I am authorized to operate:

If using a personal vehicle for company business, I confirm I maintain liability insurance with minimum limits of:

I understand I must immediately notify the company of any material change to my licence status, endorsements, suspensions, revocations, or at-fault incidents.

Authorization to Verify Driving Record

I authorize the company, its designated agents, and insurers to obtain and review my driving record and motor vehicle report from any relevant jurisdiction for the purpose of determining my eligibility to operate company vehicles or drive on behalf of the company. This authorization covers initial verification and periodic checks during employment.

I further consent to the release of driving record information to the company and acknowledge that such information will be used to assess fitness to drive, determine insurance eligibility, and for safety-related decisions. I understand adverse findings may restrict or revoke my authorization to drive for company business.

By checking the box below I provide express written consent for these verifications.

I consent to driving record checks and verification as described above.

Legal Disclosures and Company Policy Acknowledgments

At-Will Employment: I understand that unless expressly agreed in a separate written contract signed by an authorized company officer, my employment is at will and may be terminated by either party at any time, with or without cause or notice.

Equal Employment Opportunity: The company is an equal opportunity employer. Decisions regarding employment and assignments will be made without unlawful discrimination on the basis of race, color, religion, sex, national origin, disability, age, or any other status protected by applicable law.

False Statements: I understand that furnishing false, misleading, or omitted information on this form may result in disciplinary action up to and including termination of employment, and may expose me to civil or criminal penalties under applicable law.

Employment History (Most Recent)

Title/Position:    From:    To:

Title/Position:    From:    To:

Education

Graduation Date:

Professional References

Phone:    Email:

Phone:    Email:

Phone:    Email:

Applicant Certification and Acknowledgment

I certify that all information provided in this Employee Driving Licence Mandate is true, complete, and correct to the best of my knowledge. I agree to notify the company immediately of any change in my driving licence status, endorsements, or any incident that may affect my ability to operate vehicles for company business.

I understand that continued authorization to operate company vehicles or to drive on company business is contingent upon maintaining an appropriate, valid driver's licence and acceptable driving record. I further understand that a determination that I am ineligible to drive for the company may result in reassignment, suspension of driving privileges, or termination of employment where driving is an essential function of my role.

By signing below I acknowledge receipt of this mandate, consent to the described driving record checks, and agree to abide by all company policies related to vehicle operation and motor vehicle safety.

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