DISCLOSURE AND AUTHORIZATION FOR RELEASE OF MOTOR VEHICLE RECORD (MVR) INFORMATION
I authorize DKP GROUP, LLC (or prospective employer) and its designated agents and representatives, including but not limited to the company’s legal representative to obtain and review my motor vehicle record (MVR) information. I voluntarily supply the information necessary to obtain driver license information from any state in which I have been licensed to drive a motor vehicle. I have the right, upon written request, to a complete and accurate disclosure of the nature and scope of the report and a copy of my Consumer Rights under the Fair Credit Reporting Act. This authorization shall be valid in original, fax or copy form and shall sere as an ongoing authorization to procure MVR information on an ongoing basis during my employment membership or contract period.
Fill out the information below so your MVR information can be obtained
Driver License No. *
Have you ever held a driver license in any other state other than the above mentioned issuing state? *
list all state(s) *
In the past 5 years have you ever been convicted of a traffic offense (not including parking tickets) in any other state other than the above mentioned issuing state? *
list all the state(s) *
ATTACH A LEGIBLE PHOTOCOPY OF DRIVER’S LICENSE TO THIS SIGNED FORM(".jpg" & ".png" format types are allowed only) *
I certify that the information completed above is true and accurate to the best of my knowledge. I consent to a comprehensive background and driving record check.