REQUEST FOR CHECK OF DRIVING RECORD

I hereby authorize you to release the following information to A.W.A. CONTRACTING CO., INC (prospective employer) for purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability which may result from furnishing such information.
(Applicant's Name - Signature) *
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In accordance with the provisions of Sections 604 and 607 of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter 1 of Public Law 104-208), I hereby certify the following:
1. Consumer (applicant) has authorized in writing the procurement for this report;
2. Consumer (applicant) has been informed in a separate written disclosure that a consumer report may be obtained for employment purposes;
3. The information requested below will be used for a “permissible purpose” (i.e, information for employment purposes) and will be used for no other purpose;
4. The information being obtained will not be used in violation of any federal or state equal opportunity law or regulation; and
5. Before taking an adverse action based in whole or in part on the report the consumer (applicant) will receive a copy of the requested report and the summary of consumer rights as provided with the report by the consumer reporting agency.
I, also, hereby certify that this report request and the above applicant’s release notice meet the definition of “permissible uses” of state motor vehicle records under the provisions of the Driver’s Privacy Protection Act of 1994 (Public Law 103-322, Title XXX, Section 300002(a) ).

To:          Cecil W Powell & Company

                219 Newnan Street

                Jacksonville FL 32202

                FAX -   353-5722

 

Dear Sir/Madam:

 

The following named person has made application with our company for the position of ­­­­­­­­­­­driver.  As in accordance with Section 391.23, Federal Department of Transportation Regulations, please furnish the undersigned with applicant’s driving record for the past three years.





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