Motor Vehicle Report Authorization
(TO BE COMPLETED BY PROSPECTIVE EMPLOYEE)

I authorize Automated Transportation, LLC and/or its authorized representative to obtain a copy of my Motor Vehicle Record from the state office that maintains my driver records.

I understand that a third party vendor may be used to obtain my Motor Vehicle Report. I further understand that the information in my Motor Vehicle Report may be used for hiring or employment purposes, and for insurance underwriting or rating purposes.

This authorization shall remain in effect until my employment or driving duties for Automated Transportation, LLC is terminated.

Please type or print clearly  
Driver's Name:
Date of Birth:
State of License:
Driver's License #:



Signed,

___________________________________

________________
Date


Please print, sign, and fax this form to (812) 357-7784, Attn: Valerie