Occidental College Authorized Driver Application (Page 4 of 4) in pdf

Occidental College Authorized Driver Application Page 4

ADR Account No. B4182

ADR – American Driving Records and all agencies acting on behalf of American Driving Records, Inc.

Disclosure and Release Form

In connection with my employment (including contract for services) or application for employment or student

activities with Occidental College, I understand that motor vehicle reports, which may contain public and

private record information, may be requested from ADR. These reports may include but are not limited to the

following types of information: name, address, social security number, date of birth, driver license or I.D.

number, and driver record. I also understand that the information included in such reports will be taken into

consideration in deciding whether to offer me employment, continue my employment, or allow me to drive for

Occidental College.

I authorize, without reservation, any party or agency contacted by ADR to furnish the above-mentioned information.

I understand that:

ADR obtains all driver and vehicle information directly from the various state Department of Vehicles

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(or corresponding agency) and does not maintain its own database of driver and vehicle information.

ADR acts only as a courier and has no control over any of the information that a state discloses in my

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driver record or vehicle record.

If there is something inaccurate on my driver or vehicle report, I must contact the DMV directly to

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have the information corrected or updated.

I hereby authorize procurement of driver or motor vehicle records. I agree that this authorization shall remain

on file and shall serve as ongoing authorization for Occidental College to procure driver or motor vehicle

records at any time during my employment or enrollment period. I acknowledge receipt of a copy of this

document by my signature below.

Applicant’s Signature ____________________________ Date: __________________

Printed Name ____________________________ State Licensed In: ______________

Driver’s License No. _________________________ Date of Birth: _______________

Occidental College Authorized Driver Application Page 4