PIGEON FREIGHT SERVICES INC MVR

MVR - Motor Vehicle Records

AFFIDAVIT OF INTENDED USE
THIS FORM IS REQUIRED FOR OBTAINING YOUR MOTOR VEHICLE RECORDS. PLEASE COMPLETE THIS FORM ENTIRELY AND SIGN IT/DATE IT. YOUR MVR WILL BE ACCESSED BY PIGEON FREIGHT SERVICES INC.
PART A: TO BE COMPLETED BY THE DRIVER
Full name:*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Applying for*
Trailer type*
Driving*
Experience*

Driver Work history: *

Rows	Start-End Month/Year	Company Name	Truck & Trailer Type
1
2
3
4
5
6
7
8
9
10
11
12

Additional information about Driver Work history:
Any Moving Violations (Tickets) in the past 3 years? *
Date of birth:*

MonthDayYear
Date
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CDL Number:*
CDL State:*
CDL Expiration:*

MonthDayYear
Date
INFORMATION MAY BE USED ONLY FOR THE FOLLOWING APPROVED DRIVER PRIVACY PROTECTION ACT (DPPA) PURPOSES. SELECT THE PURPOSE(S) FOR WHICH YOU WILL BE ORDERING MVRS:
Upload CDL-A photo*

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By a business that will use the information to verify the accuracy of information submitted by individuals for the purposes of preventing fraud, pursuing legal remedies against or recovering a debt or security interest.

By an insurer or insurance support agency in connection with claims, investigations, antifraud activities, rating or underwriting.

By an employer/agent or insurer to obtain or verify information on a Commercial License Holder.

Written consent of the person whose record is being requested (Available in: AR, CA, CO, DC, FL, HI, IL, KY, MA MN, NM, NY, ND, RI, VT, VA, WY)
Under the penalty of perjury, I attest that I shall not obtain, resell, transfer, or use the information in any manner prohibited by law. I understand that motor vehicle or
driver records that are obtained, resold, or transferred for purposes prohibited by law may subject me to civil penalties under federal and state law.
Signature*

Clear
Today's date*

DayMonthYear
Date
Prepared by Pigeon Freight Services Inc

16830 Chicago Ave Lansing, IL, 60438

(813) 765-0109
(847) 443-1784
(206) 561-2718

recruiting@pigeonfreight.com

www.pigeon-freight.com

MVR - Motor Vehicle Records