Driver Application form

U.S DEPARTENT OF TRANSPORTATION

Mortor carrier safty program

Inquiry to srare agency for

Driver Record

391.23

Drivers Name

Drivers Operations Lic No.

Drivers Social sec No.

Dear

The above listed individual has mafe application with us for employment as a driver.Application has indicated that the abovr numbered operator's locensed or permit has been issued by your state by applicent and that is in good standerd

In accordance with section 391.23 a(1) and (b) of the fedral motor carrier safty regulations , we are requied to make inquiry into the driving record during the preciding 3 years of every state in which an applicant-driver has held a motor vehicle oprtators licence or permit those 3 years

There fore please certify to us what the indusual driving license

In the event that this enquiry does satisfy your requirement for making such enquiry ,please send us such forms if yours as are necessaty for us to complete iur enquiry in to the driving recoof this indivisual

Respectly Yours

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