AUTHORIZATION TO OBTAIN DRIVING RECORD

AUTHORIZATION TO OBTAIN DRIVING RECORD
I hereby authorize you to obtain my driving record as required by Section 391.23 of the Federal Motor Carrier Safety Regulations. The Company is released from any and all liability which may result from furnishing such information.
Drivers Signature

Clear
Full Name of Applicant
Applicant's Street Address
Applicant's City
Applicant's State
Applicant's Zip Code
Applicant's Date of Birth

MonthDayYear
Date
Applicant's Social Security Number
Applicant's Driver's License Number
State In which License was issued
Should be Empty: