MOTOR VEHICLE REPORT CONSENT FORM
By signing below, I give my consent for Lurleen B. Wallace Community College to complete a
background check on my previous driving record in accordance with the college’s Use of
College Vehicles for Travel Policy, as found in Section 6: Employee Leave and Travel of the
LBWCC Policy and Procedures Manual. As part of this procedure, the College has my
permission to order Motor Vehicle Records (MVRs) from any and all states in which I have
currently and previously held a drivers license. I understand that if uninsurable through Lurleen
B. Wallace Community College’s auto insurance carrier, that I will be prohibited from driving a
vehicle on official college business whether using a college owned vehicle, my personal vehicle,
or any other vehicle. I further understand that failure to release consent for Lurleen B. Wallace
Community College to conduct a background check on my previous driving records means, at a
minimum, that I forfeit my driving privileges. In the event that I forfeit my driving privileges, I
understand that, since my job duties include driving, my duties will be reviewed to determine
whether I can continue my position without driving and, if so, which additional non-driving
duties the College will require.
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Employee’s Name (Print)
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Employee’s Signature Date
*PLEASE BE SURE TO ATTACH A PHOTO COPY OF YOUR DRIVER’S LICENSE.