MVR Authorization

MVR Authorization
Consumer reports may be obtained as part of the NH Communications, Inc. (Company) evaluation of my job application/employment. The reports may be obtained by West Texas Insurance Exchange, Inc. or other authorized agent, and may include my driving record, an assessment of my insurability under the Company's insurance coverages or other consumer reports. By signing this disclosure, I hereby authorize the Company to procure such reports and additional reports about me from time to time, as it deems appropriate, to evaluate my insurability or for other permissible purposes.

Authorized Company:
NH Communications, Inc
PO Box 949
Andrews, TX 79714
Driver License class*

Class AClass BClass C
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Date
Driver License*
State where issued*
Previous License Number
Only needed if current license issued less than 3 years ago
Previous State
Only needed if current license issued less than 3 years ago
CDL Experience (years)
If applicable
Signature*
Type your full name here in lieu of a written signature
Should be Empty: