Subject: MVR Release Consent Form

MVR Release Consent Form

In conjunction with my employment, volunteer work, or contract work at/with, Anthony Bill Trucking, I consent to the release of my Motor Vehicle Record (MVR) to the company. I understand the company will use these records to evaluate my suitability to fulfill driving duties that may be related to the position for which I am applying. I also consent to the review, evaluation, and other use of any MVR I may have provided to the company.

This authorization shall continue in effect until revoked by the undersigned in a subsequent writing delivered to you.

Last name

First name

Middle Name or Initial

CDL#:

CDL State:

Expires:

Date of Birth:

Phone

Address:

City:

State:

Zip Code:

Years of Experience

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Signed (electronically) by

Date

Month

Day

Year

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