Fillable Driver Consent Form Fillable2018 (Central Connecticut State University)

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Driver Consent Form Fillable2018 (Central Connecticut State University)

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The Driver Consent Form Fillable2018 (Central Connecticut State University) form is 1 page long and contains:

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DAS.CT.GOV
Affirmative Action/Equal Opportunity Employer
On behalf of the Department of Administrative Services, I am requesting the Department of
Motor Vehicles provide Fleet Operations with driving history for driver named below.
DAS/FLEET SIGNATURE: TITLE:
Express Consent to Disclose Department of Motor Vehicle Record
I hereby authorize the Fleet Operations Director of the Connecticut Department of
Administrative Services (DAS), or his designee, to obtain access to and review my driving
history record that is in the files of the Department of Motor Vehicles for the limited purpose
of evaluating my qualifications to operate a state-owned motor vehicle.
I understand this authorization will remain in effect until such time that I expressly revoke my
consent in writing to the DAS Director of Fleet Operations.
PRINTED NAME: DATE:
_____________________________ ______________________________
ADDRESS: LICENSE NUMBER:
______________________________ CT #
_
______________________________
AGENCY: SIGNATURE:
______________________________ ___________________________________
Check employee type:
SEASONAL CONTRACTUAL
VOLUNTEER
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Driver Consent Form Fillable2018 (Central Connecticut State University)

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Completed 19 July 2020

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