County College of Morris
SUPPLEMENTAL DRIVING INFORMATION
Please print or type all information.
Dept./Div:
Supervisor:
Date of Hire:
Name:
Telephone:
Address:
City:
State & Zip:
Employee is required to notify the College of any changes of driver license status.
Risk Management:
Granted / Denied
By
Date
DDC
By
Date
Revised April 2013
DRIVER LICENSE INFORMATION
State
Driver’s License Number
Type
Expiration Date
*NOTE: PLEASE ATTACH A PHOTOCOPY OF BOTH SIDES OF YOUR DRIVER’S LICENSE.
DO YOU CURRENTLY POSSESS A C.D.L.?
IF SO, WHAT ENDORSEMENT(S)?
HAVE ANY LICENSES OR PERMIT/PRIVILEGES BEEN SUSPENDED?
Yes
No
(If yes, specify in detail and attach a separate sheet if necessary)
This form is intended to provide supplemental information for a general employment application and is not intended to meet D.O.T. requirements.
Employee Signature:
Date:
Dept. Head Signature:
Date: