MVR Request Form

DRIVER AUTHORIZATION

I understand that the named Company has my authorization to thoroughly investigate my driving record. I understand that the background consumer report may may include information about my character, general reputation, personal characteristics, and mode of living as well as information that is not limited to, the following areas: Motor Vehicle Records, Drivers License Verification, FMCSA PSP Records, Drug Screening, Previous Employment Verification, Sexual Offender Lists, County Court Records and Identity Verification. I understand that Title 49 of the Federal Code of Regulations, § 391.23, requires that my prospective employer and/or its agent(s) may contact all former employers of a driver within the last three years under the regulation of the Department of Transportation. Information such as dates of employment, position, accident history, as well as information pertaining to my drug and alcohol testing history, may be requested from each employer in accordance with Section 391.23 and 49 CFR 40.25.

If applicable and in accordance with DOT Regulation 49 CFR Part 391.23 and 49 CFR Part 40, I hereby authorize release of my DOT- regulated drug and alcohol testing records by the DOT- regulated employers to the requesting employer via MVRcheck.com or another consumer reporting agency. I understand the information released pursuant to this section is limited to the following DOT- regulated testing items, including pre-employment testing results occurring during the previous three (3) years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusal to be tested (including adulterated and/or substituted tests); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) any documentation of completion of the return-to-duty process following a rule violation. Furthermore, I authorize the Company and MVRcheck (agent of Company) to conduct limited queries of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse for the duration of my employment. I understand that if the limited query conducted by Company/MVRcheck indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Company/MVRcheck without first obtaining additional specific consentfrom me. I further understand that if I refuse to provide consent for Company/MVRcheck to conduct a limited query of the Clearinghouse, Company must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required byFMCSA’s drug and alcohol program regulations.

I hereby authorize MVRcheck.com an agent of the Company to make a thorough background investigation of all information given by me to the Company by preparing a consumer report and/or investigative consumer report. This authorization shall remain on file by Company for the duration of my employment and will serve as ongoing authorization for Company and MVRcheck.com to procure my driving and background records at any time during my employment period. Consumer reports and/or investigative consumer reports are to be generated for employment, promotion, reassignment, retention as an employee or insurance underwriting. I understand that Company may take adverse action affecting my employment, based on information in my background report. Upon written request and provided identification, MVRcheck.com will supply a copy of the completed background report along with a copy of an individual’s rights under the FCRA / ICRA and I also understand that I have the right to dispute the accuracy of my driving record with MVRcheck.com - Click for Driver Summary of Rights. A copy of this form is as valid as the original.

The following information is required for identification purposes when checking records. It is confidential and will not be used for any other purpose.