Form Cs-043 - Application For Salesman'S License Page 3
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3Motor Vehicle Administration
CS-011 (12-13)
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
MVA Criminal Record Request Form
Please place your photo driver’s license below and photocopy.
By my signature, I authorize the Motor Vehicle Administration to perform a criminal background check.
Signature
Date
Name of Business
Type of License:
Dealer
Salesman
Professional Driver Instructor
Title Service Agent
Other
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Instructions for Criminal Background Request
This form is to be used for the processing of your Maryland criminal background check. At the present time no fee will be charged
for this service.
Maryland Residents:
This form must accompany all applications from licensees or anyone with a financial interest in a business.
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Photocopy a clear legible copy of either your Maryland Photo Driver’s License or a Maryland Photo ID card on the
front of this form.
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If you have a change of address that does not appear on your license or your ID, please note it on the form.
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Sign the photocopy.
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The photocopy which contains your original signature must be submitted with your application to the Motor
Vehicle Administration.
Out of State Residence:
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Applicants will be required to request Criminal Justice Information System background checks from the
appropriate Law Enforcement Agency in their state of residence.
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The background checks should not be sent directly from the appropriate Law Enforcement Agency to the Motor
Vehicle Administration.
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For identification purposes you must submit a clear legible copy of your out-of-state driver’s license or a
Photo ID on this form.
MVA Use Only:
For more information, please call: 410-768-7000 (to speak with a customer agent).
TTY for the hearing impaired: 1-800-492-4575. Visit our website at:
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