HR Driving Registration Form

HR DRIVING REGISTRATION FORM

Personal Information

Reporting Manager:    Date Hired:

Phone:    Email:

Driver's License Information

Driver's License Number:    Issuing State:    Expiration Date:

Class/Endorsements:

Vehicle Information

Vehicle Use: Company Vehicle    Personal Vehicle used for company business

Year:    VIN:

Insurance Information

Policy Number:    Coverage Limits:

Driving History (Last 5 Years)

Have you had any at-fault accidents in the last 5 years?   Yes   No

Any moving violations (tickets) in the last 5 years?   Yes   No

Have you ever had a driver's license suspended or revoked?   Yes   No

Employment History (required)

Title:    Dates Employed:

Title:    Dates Employed:

Education

References (Professional)

Emergency Contact

Legal Disclosures and Acknowledgements

At-Will Employment: I acknowledge that my employment, if any, is at-will and may be terminated by either party at any time with or without cause, except as otherwise provided by applicable law or written agreement signed by an authorized representative of the company.

Equal Opportunity: The company provides equal employment opportunity and does not discriminate on the basis of protected characteristics. Compliance with applicable laws and company policies is required.

Authorization to Verify Driving Record: By signing below I expressly authorize the company or its designated agent to obtain motor vehicle records, driving history abstracts, and other investigative consumer reports as permitted by law. This authorization is continuous while I am a registered driver for company business unless I revoke it in writing.

Background and Drug/Alcohol Testing: I understand the company may require background checks and drug/alcohol screening as a condition of driving for company business and that refusal or a positive result may disqualify me from driving duties.

Insurance and Liability: If using a personal vehicle for business, I certify that I maintain current automobile liability insurance meeting the company minimums and that I will notify the company of any changes. I agree to notify my insurer that the vehicle may be used for business purposes if required by the insurer and to provide proof of coverage upon request.

Safety Policy Acknowledgement

I acknowledge that while operating a vehicle on company business I will comply with all company safe driving policies including, but not limited to, wearing a seat belt, obeying posted speed limits, refraining from handheld mobile device use while driving, and abstaining from driving under the influence of alcohol or drugs. I understand violations may subject me to disciplinary action up to and including termination.

I certify that all information on this form is true, complete, and correct to the best of my knowledge. I understand that falsification, omission, or misrepresentation may result in denial of driving privileges and disciplinary action.

I authorize the company to contact the employers listed and any other individuals or organizations to verify the information provided, including driving and safety records. I release those parties from any liability arising from providing such information.

Additional Information

Applicant Certification

I certify under penalty of perjury that the statements made in this registration are true and complete. I understand that submission of this form authorizes the company to access motor vehicle records and related background information. I agree to report any change in my driving status, license, insurance, or driving eligibility immediately.

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