Motor Vehicle Reporting Disclosure

Motor Vehicle Reporting Disclosure Statement
In accordance with the provisions of Sections 604(b)(2)(A) of the Fair Credit Reporting Act (Public Law 9 1-508), as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that a consumer report may be obtained on you for employment purposes.

I acknowledge the receipt of the above disclosure and authorize the above named company to obtain a motor vehicle report only on me for employment purposes. This authorization is ongoing in the event such a report is needed in the future.
Electronic Signature

The following, if checked, constitutes an electronic signature and agreement with all of the above statements and disclosure forms.Signature
Today's Date
Name as it appears on driver's license
Date of birth
Issuing State
Driver's License Identifying Number
Expires

Page 2 of Application for Employment