Ordering Of MVR Release Form

I have applied for employment with [COMPANY NAME]  (the Company) in a position that requires me to operate an automobile or truck.  As a condition for my application being considered, I understand and agree to allow the ordering of my Motor Vehicle Driving Record (MVR).  I understand that if my driving record contains certain types of violations or problems as reviewed by the Company, I shall not be considered further for a car or truck driver position.

I hereby authorize any representatives of the Company or an authorized insurance professional retained by the Company to order such records and to provide the results to the Company.  Furthermore, I release the Company and any person affiliated with with this action and any such institution or person conducting the screening, from liability.

Applicant's signature: _________________________________________________

Applicant's name: ____________________________________________________

Date: ______________