May 1, 2009
Marquette University
Driver Authorization Application
This form is intended for use by persons who drive Marquette University owned, leased or rental vehicles on university business,
regardless of their status as an employee (e.g. faculty, staff, etc.), student, student employee or volunteer. Carefully read this form and
provide the following information. Note: Allow 5-7 days for approval (depending on the applicant’s state license this approval
process may be longer). Return this form to your Department contact person in a sealed envelope marked “confidential”.
Driver’s name as it appears on License:
(First, Middle and Last Name)
Status: Employee Student Employee Student Volunteer
Indicate your State of Residency: Yrs of Residency
I agree to amend this application in the event of a name change on my driver’s license as a result of marriage or divorce. I understand
that my driver information will be included in a database that will be checked periodically. Any negative change in the status of my
driving record may result in the revocation of the privilege of driving on University business. I agree that I will notify my Department
contact person if there is any change in my driving status or my motor vehicle record.
NOTE: A driver of a university vehicle must have a valid permanent Wisconsin (or other US state jurisdiction) driver’s license.
Non residents (sixteen or older) must secure a Wisconsin license within 60 days of establishing residency. You are a resident
of the State of Wisconsin if you consider it to be your home. Factors used to determine residency are where you vote, where
you pay income taxes, where you own real property, where you register your car, where you hold professional licenses, and
where you claim residency in legal proceedings and filings. It is up to you to establish your state of residence.
Fair Credit Reporting Act Disclosure Statement
Motor Vehicle Record (MVR)
In accordance with the provisions of the Fair Credit Reporting Act (FCRA), you are hereby informed that a Motor Vehicle Record will be
obtained on you and used for employment related purposes. Before taking any adverse action based in whole or in part on your Motor
Vehicle Record, Marquette University will provide you with a copy of your Motor Vehicle Record and a written summary of your
consumer rights under the FCRA, as prescribed by the Federal Trade Commission under FCRA I 609 (c) (3).
I, the undersigned, acknowledge receipt of the above disclosure and authorize Marquette University to obtain a Motor Vehicle Record
about me for its use related to employment purposes. This authorization shall remain on file and shall serve as ongoing authorization to
procure future MVR reports at any time during my employment, contract or enrollment period. Indicate license information from your
state of residency.
License
Name
Please print name as it appears on License
Indicate Dates
License Was Held
State
Expiration Date
I have been involved in or ticketed for more than 3 motor vehicle violations and/or accidents in
the past three years.
Yes No
Applicant’s Signature
Date
Applicant Email Address
THIS APPLICATION MUST BE APPROVED BY DEPARTMENT PRIOR TO DRIVING.
Department Name
Department
Copy of Driver License on File
Yes No
Date
