Washington Department Of Licensing
Certification
Employee or Prospective Employee Request
That I, ___________________, am an employee or prospective
employee of the company named below and that I request a copy of my official
driving record in the state of Washington be released to my employer or their
agent.
Authorization of employee or prospective
employee for release of abstract of driving record
Signature_______________________Date_________WA
License Number____________________
Full Name:______________________Date Of
Birth_____________
Employer Attestation
(A) That the company named below is an employer or prospective
employer of the above named individual and that I am a representative authorized
to bind said company.
(B) That Accurate Public Records is acting as an agent on behalf
of_____________________________who is acting as an agent on our behalf to obtain
the abstact of driving records of the above named individual.
(C) That abstacts of driver record shall be used exclusively to
determine whether the above named individual should be employed to operate a
school bus or commericial vehicle upon public highways, and that no information
contained therein shall be divulged, sold, assigned, or otherwise transferred to
any third party. A commercial vehicle is defined as any vehicle the principal
use of which is the transportation of commodities, merchandise, produce,
freight, animals, or passangers for hire.
(D) That the information comtained in the abstracts of driver
records obtained from Washington State Department of Licensing shall be used in
accordance with the requirements and in no way violate the provisions of ROW
46.52.130 Attached in part for easy reference.
Company Name:____________________________________
Address:
____________________________________
Name:
____________________________Title________________
Signature:
____________________________Date________________
Print and Fax to 229-420-0805
