Employment Driving Record Release

EMPLOYMENT DRIVING RECORD RELEASE

Personal Information

Date of Birth:    Driver's License No.:    State of Issue:

Phone:    Email:    Social Security No.:

Position Information

Department:    Reporting Manager:    Proposed Start Date:

Salary / Wage:    Employment Type:   Full-time   Part-time   Contract/Temporary

Employment History (Most Recent)

Title:    From:    To:

Employment History (Previous)

Title:    From:    To:

Education

Graduation Date:    Major / Field:

Professional References

Legal Disclosures

At-Will Employment: I understand that, except where an express written agreement provides otherwise, my employment with the employer is at-will. Either I or the employer may terminate the employment relationship at any time, with or without cause or prior notice.

Equal Opportunity: The employer is an equal opportunity employer and does not unlawfully discriminate on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable law.

Authorization and Release — Motor Vehicle Record

I, the undersigned, authorize the employer and its designated agents to obtain and review my motor vehicle record, driving history, accident reports, suspensions, revocations, convictions, and any other driving-related information maintained by state motor vehicle departments, law enforcement agencies, courts, and third-party reporting agencies (collectively, Driving Records). This authorization applies to present records and any records that exist for a period of up to seven (7) years prior to the date of this release unless otherwise restricted by applicable law.

Scope of Request: I expressly permit retrieval of my full Motor Vehicle Record (MVR), including but not limited to DOT and non-DOT license convictions, suspensions, employee driving history, accident involvement, and license status. I understand the employer will use this information to evaluate my suitability for employment, assignment, continued employment, and/or assignment to driving duties.

Consent for Periodic Checks: I consent to periodic driving record checks during my employment as required by the employer and applicable law.

Third-Party Reporting Agencies: I understand that the employer may use outside vendors to obtain Driving Records and that such vendors are authorized to provide copies of the Driving Records to the employer.

Rights and Disclosure: I understand that, where required by law, I have the right to be provided a copy of any report obtained and to dispute inaccurate information with the reporting agency. I consent to the release of Driving Records to the employer and acknowledge receipt of any notices required by law regarding consumer reports where applicable.

Limitations and Indemnity: I release and hold harmless the employer, its agents, and any individual or entity providing Driving Records from liability arising from the request, release, or use of such records, except for willful misconduct or gross negligence. I understand that adverse information in Driving Records may affect hiring or retention decisions.

Applicant Certification and Authorization

I certify that all information provided in this form is true, complete, and correct to the best of my knowledge. I understand that falsification, omission, or misrepresentation of facts may result in denial of employment or termination if employed. I authorize the employer to contact previous employers, references, and other persons or entities necessary to verify the information provided and to obtain Driving Records as authorized above.

Acknowledgment

By signing below I acknowledge that I have read and understand this Employment Driving Record Release. I authorize the release of my Driving Records as described herein and consent to the employer's use of the information for employment-related purposes.

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