DIY Legal Forms

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Driving Record Verification

Date:

Construction Company:

Employee:

Address:

Phone Number:

Driver's license number:

State:

Please answer the following questions:

1. Has your license ever been suspended? (__) Yes (__) No

If yes, please explain:

2. Have you ever been cited for driving under the influence? (__) Yes (__) No

If yes, please explain:

3. Have you received any moving violations within the past 3 years? (__) Yes (__) No

If yes, please explain:

4. Have you been involved in any accidents within the past 3 years? (__) Yes (__) No

If yes, please explain:

I give permission to allow a verification of my driving record to be performed.

I certify that the above information is true and correct.

Signed: ________________________

Date: __________.