For the sole purpose of the determination and evaluation of my motor vehicle operating record and pursuant oto the State and Federal regulations of compliance, I authorize CLG Financial Corp and South Orangetown Ambulance Corps to obtain my Motor Vehicle Record. I understand that this record may contain personal information* in addition to any/all driver violations and/or accidents, which may be on record on through the states of NY, NJ, CT & all 50 U.S. States — State Department of Motor Vehicles.
I also authorize release of this information to my employer.
*Personal information means information that identifies an individual including an individual's photograph, social security number, driver identification number, name, address, and telephone number. It does not include information on vehicle accidents, driving violations, and driver status.