Motor Vehicle Record Review Consent Form

I understand that I am required to maintain a valid driver’s license. Additionally, I grant Sanfilippo and Sons Insurance Services the right to review my motor vehicle driving record at anytime.

My current driver’s license is issues from the State of _______________ and is #_____________.

If involved in an accident, the police report will be used to determine who was at fault. I understand that I am responsible for obtaining a copy of the police report. If the police report is not obtained, I will be considered at fault.

I am required to report any license revocation or suspension, regardless of whether the change was prompted by business or pleasure use of a vehicle, no later than 24 hours after the event occurs.

I understand that I can be terminated if I knowingly operate a company vehicle while my driver’s license is suspended or revoked.

In accordance with the company’s MVR review program, a review of my motor vehicle record may result in the following action:

•       I may be required to attend an 8-hour defensive driving training class prior to being allowed to drive a company vehicle. The class must be completed within 30 days of being put in a non-driving status. It will be completed during off duty time and at my expense.  
•       I may be put in a non-driving status for a year pending the next annual review.
•       I may be terminated if a non-driving position is not available.

 

 

Employee Signature: ________________________

 

Date: ______________