RTH | Motor Vehicle Record Disclosure

First Name: *

Middle Name: *

Last Name: *

Years Driving Similar Equipment *

Social Security Number: *

Date Of Birth: *

Driver’s License Number *

State Of Issuance *

Driver's License (Front & Back) *

Maximum file size: 8.39MB

In connection with my ongoing employment or my application for employment, should I have or secure a position with Rock The House Entertainment, I understand that a motor vehicle record, which contains public record information, may be requested. I further understand that such report(s) will contain personal information and public record information concerning my driving record from federal, state and other agencies that maintain such records, as well as independent services that provide driving record information.

I authorize, without reservation, any party or agency contacted to furnish the above-mentioned information to Rock The House Entertainment or its agent.

I hereby authorize procurement of my motor vehicle report. If hired, this authorization shall remain on file and shall serve as ongoing authorization during my employment. Rock The House Entertainment’s commercial auto insurer and agent will also use this information in conjunction with loss control and safety review efforts. *

Clear