Driving Record Review Authorization Form
college-owned or rental vehicle,
comply with all state driving regulations.
I understand that any traffic vio lations incurred while driving a College owned or rental
vehicle are my responsibility and any associated fees will not be reimbursed by the
I understand my employer will periodically review my driving record to determine continued eligibility
to drive a company vehicle or rental vehicle.
I authorize my
employer, or its designated agent, to periodically review my driving record and obtain a
driving record report. This
authorization is valid as long as I am an employee or employee candidate
and may only be rescinded in writing.
I authorize my employer, or its designated agent, to submit a photocopy of my driver’s license to
the College’s designated Car Rental Company as required to reserve a vehicle for my use.
Driver’s License Number
Employee Signature Date
Employee Title & Department
Employee Email Address
Facility Management Review Signature Date
To request a College-owned or rental vehicle, please complete and submit this Driving Record Review
Authorization Form (if not already on file), a photocopy of your driver’s license (for rental vehicles only) and
the Vehicle Request Form to:
│ Facilities Operations Secretary │ Plant Operations Building, PO 117
firstname.lastname@example.org │ O: 734.677.5300 │ F: 734.677.5475