Background Check: Authorization to Obtain Motor Vehicle Records

Name: _______________________________________________________

Position: ______________________________________________________

Driver's License Number: _________________________________________

I understand that driving a company vehicle (or my own vehicle, as required) is a requirement of the position I am being considered for and that having and maintaining a satisfactory driving record is a condition of my employment. I agree to allow [Company Name] to check my driving record prior to hire and to check it periodically thereafter. I further agree to report to my supervisor immediately any license suspensions, serious accidents or offenses, or any other condition that may affect my ability to drive a [Company Name] vehicle (or my own vehicle, if I am required to drive it) after I am hired.

I understand that [Company Name] will use this information for employment purposes only and will not furnish this information to a third party without my written consent.

[Editor's note: Do not include the following release if background check is run by a consumer reporting agency and therefore covered under the Fair Credit Reporting Act.]

I agree to release [Company Name], its employees and those who supplied the company with the information from any liability for any damage that may result from furnishing the requested information or my failure to be hired for the position for which I am applying.

Signature: _________________________________            Date: _________________