Employer Motor Vehicle Record (MVR) Request Form

Employer Motor Vehicle Record (MVR) Request Form
Complete this form to request a motor vehicle record for employment-related screening. Do not provide sensitive identifiers—only required information for processing your request.
Employer/Company Name
Employer Contact Name
First NameLast Name
Employer Contact Email
example@example.com
Employer Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Full Name
First NameLast Name
Applicant Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Applicant Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
State of Driver’s License (Do not enter license number)
Position/Job Title for Screening
Purpose of MVR Request
Should be Empty: