Motor Vehicle Authorization Form Header Image

Motor Vehicle Authorization Form (MVR)

Type "N/A" if this does not apply to you.
Purpose*
Please describe why you are applying to be cleared as an Approved Driver for Biola University. If you are driving for a specific trip, please indicate that under "Other."

Authorization For Motor Vehicle Report

(As it appears on your Driver's License)
Address*

The information contained above must be as it appears on your driver's license. Please note that Biola does not accept an international driver's license. You must apply for a California Driver's License within 10 days of establishing residency in the state.

Date Of Birth*
This is required to order your Motor Vehicle Record. If you do not want to enter your Social Security Number on this form, please type "N/A" here. Instead, you may call (562) 944-0351 x5042. We cannot process your Motor Vehicle Record without your Social Security Number.

Authorization For Motor Vehicle Report



I am aware that consumer and motor vehicle reports may be obtained as part of Biola University’s evaluation of my job application and/or employment, or if I am to drive on behalf of Biola University or in connection with a Biola-sponsored or sanctioned event. The reports may be procured by Biola University or its insurance company representative(s), and may include personal information obtained from state motor vehicle departments, my driving record, an assessment of my insurability for the insurance program, or other consumer reports.

By checking the box below, I hereby provide my electronic signature authorizing Biola University or its insurance company representative(s) to procure such information and reports, as well as additional reports about me from time to time as deemed appropriate, to evaluate my insurability or for other permissible purposes. Additionally, I acknowledge that I have read and understood the Approved Drivers Policy (http://offices.biola.edu/hr/ehandbook/3.35/) in the Biola University Employee Handbook, which determines my clearance as a driver and should dictate my driving behaviors.

This authorization will remain in force for as long as I am an employee, independent contractor, volunteer, applicant, guest, or student of Biola University, Inc.


Signature*

EMPLOYER PULL NOTICE PROGRAM



DMV Logo


A PUBLIC SERVICE AGENCY

AUTHORIZATION FOR
RELEASE OF DRIVER RECORD INFORMATION


I,

(As it appears on your Driver's License)

California Driver License Number

hereby authorize the California Department of Motor Vehicles (DMV) to disclose or otherwise make available my driving record to Biola University.


I understand that my Biola University may enroll me in the Employer Pull Notice (EPN) program to receive a driver record report at least once every twelve (12) months or when any subsequent conviction, failure to appear, accident, driver's license suspension, revocation, or any other action is taken against my driving privilege during my employment.

I am not driving in a capacity that requires mandatory enrollment in the EPN program pursuant to California Vehicle Code (CVC) Section 1808.1(k). I understand that enrollment in the EPN program is in an effort to promote driver safety, and that my driver license report will be released to Biola University to determine my eligibility as an approved driver for my employment. 

EXECUTED AT:


DATE*
SIGNATURE OF EMPLOYEE*

For Office Use Only



I, Rebeka Preston (AUTHORIZED REPRESENTATIVE), of Biola University, Inc. (COMPANY NAME), do hereby certify under penalty of perjury under the laws in the State of California, that I am an authorized representative of this company, that the information entered on this document is true and correct, to the best of my knowledge and that I am requesting driver record information on the above individual to verify the information as provided by said individual. This record is to be used by this employer in the normal course of business and as a legitimate business need to verify information relating to a driving position not mandated pursuant to CVC Section 1808.1. The information received will not be used for any unlawful purpose. I understand that if I have provided false information, I may be subject to prosecution for perjury (Penal Code Section 118) and false representation (CVC Section 1808.45). These are punishable by a fine not exceeding five thousand dollars ($5,000) or by imprisonment in the county jail not exceeding one year, or both fine and imprisonment. I understand and acknowledge that any failure to maintain confidentiality is both civilly and criminally punishable pursuant to CVC Sections 1808.45 and 1808.46.

To obtain a driver record on a prospective employee you may submit an INF 1119 form. To add this driver to the EPN Program you must submit the applicable forms: INF 1100, INF 1102, INF 1103, INF 1103A form. You may obtain forms at our website at www.dmv.ca.gov/otherservices, or by calling 916-657-6346.



THIS FORM MUST BE COMPLETED AND RETAINED AT THE EMPLOYER'S PRINCIPAL PLACE OF BUSINESS AND

MADE AVAILABLE UPON REQUEST TO DMV STAFF.


DO NOT RETURN THIS FORM TO DMV.


INF 1101 ENGLISH (REV. 9/2004) WWW