area.
BRYN MAWR COLLEGE
Road Test
Please
DRIVERS LICENSE REVIEW FORM
photocopy
Bryn Mawr College Transportation Department
Date: ___________
101 N. Merion Avenue
applicant’s
Bryn Mawr, PA 19010
Passed | Failed
driver’s
Phone: (610) 526-5206 Fax: (610) 526-5204
license
Requestor Information:
Instructor:
Company Name: Bryn Mawr College
_______________
into this
Contact Person: Steve Green
Contact Phone: 610-526-5206
Contact Fax: 610-526-5204
Applicant/Subject Information:
(Please Print All Requested Information)
Name: Graduation Year:
Address on License:
City: State: Zip:
Sex: Date of Birth:
Driver’s License Number: State:
Email Address: Phone:
Organization Requesting Certification:
In connection with any application made by me, I understand that investigative background inquiries may be
made on me concerning matters of motor vehicle information. I understand that you may be requesting
information from various Federal, State, and other agencies which maintain records concerning past activities
relating to my driving records.
I authorize, without reservation, any party or agency contacted to furnish the above mentioned information and
release all parties involved from any liability and/or responsibility for doing so. I hereby consent to any potential
employer obtaining the such information from Sonic e-Learning Inc. and/or any of their agents. This
authorization and consent shall be valid in an original, fax or copy form. I recognize that these inquiries may
be made randomly in the future and no further authorization is required by me.
I,
hereby authorize AlertDriving.com on behalf of
Bryn Mawr College to request an abstract of my
Driver’s Operating Record and to administer
a web based safety training course via email and to administer as a prerequisite for certification to drive
College vehicles. I hereby release both Bryn Mawr College and AlertDriving.com from any liability of any
kind or nature relative to their receipt of any abstract of my driving record or administration of the web based
training course.
Applicant’s Signature: X
Date:
FOR OFFICIAL USE:
(Pennsylvania) Request for Driver’s Info: Faxed:
Driver Database: Online Prog’s: MVR Status: Billed:
Road Test Date: Time: Note:
