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DRIVING CHECK REQUEST AND RELEASE FROM LIABILITY

The category driving postion being applied for is:

(To be completed by Human Resources)

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 to check my driving record prior to hire and to check it periodically thereafter. I further agree to report any license suspensions, serious accidents or offenses, or any other condition to my supervisor immediately that may affect my ability to drive at .

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

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

First Name:
Last Name:
Date of Birth:

Driver's License Number:

State of License:


  Signature
(checking the checkbox above is equivalent to a handwritten signature)