It is understood that my job position requires or may require me to drive either a company owned vehicle or my own vehicle on company business. I understand the insurance company writing your automobile insurance required a copy of my driving record to assess my insurability, I also understand that I have the right to see a copy of my Motor Vehicle record. By this letter, I hereby authorize the insurance company and or its agent to obtain the necessary Motor vehicle records and authorize them to send a copy of my Motor Vehicle record to my Employer.

*Please provide any additional information that may be useful if ordering an out of state license.

The state of California and the Federal Trade Commission (FTC), require that all inquiries to the DMV about a person’s driving record follow the guidelines as set forth in the Fair Credit Reporting Act (FCRA). It requires approval, in advance, by that person, 604 (a) (2). By completing the Driving Record Request Form, below the requestor gives his/her consent to Insurance Service to request an MVR and to release or share the information only with prospective insurance carriers, for the sole purpose of determining eligibility for insurance coverage. Only the fact that the driving history does or does not meet the insurance company’s underwriting guidelines will be shared with the policyholder or prospective policyholder. (If the employer wishes to obtain a copy of an MVR they will be instructed to contact a credit-reporting agency directly per 60 (a)(3)(B)

This consent will expire on the date of termination from employment or once a decision has been reached not to hire prospective employee. A copy of this authorization is available upon request.

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed.

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained.

Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

*Includes vehicles having GVWR or GCVWR of 26.001 lbs. or more or designed to transport 15 or more passengers, or any size vehicle to transport hazardous materials of a type or quality requiring placarding of the vehicle.

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision.

I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23.

I understand that I have the right to:
• Review information provided by current/previous employers;
• Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and
• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.