Fillable MVR RELEASE CONSENT FORM

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MVR RELEASE CONSENT FORM

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MVR RELEASE CONSENT FORM
In conjunction with my employment, at ___________________________ (“the company”),
I ___________________________ (employee/applicant name) Consent to the release of
(print name)
my Motor Vehicle Record (MVR) to the company. I understand the company will use these
records to evaluate my suitability to fulfill driving duties that may be related to the position for
which I am applying. I also consent to the review, evaluation, and other use of any MVR I may
have provided to the company.
This consent is given in satisfaction of Public Law 18 USC 2721 et. Seq.. “Federal Drivers Privacy
Protection Act”, and is intended to constitute “written consent” as required by this Act.
________________________________ ________________________________
Employee/Applicant Signature Date
________________________________ ________________________________
Date of Birth Social Security Number (last 4 digits)
________________________________
Drivers’ License Number
________________________________
License Expiration Date
________________________________
Issuing State
(Required for all drivers)
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MVR RELEASE CONSENT FORM

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Completed 18 January 2021

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