MVR & Background Check Release Form

Tel.: +1 (704) 519-5150

Effective September 13, 1997, all motor vehicle records are subject to the Federal Driver's Privacy Protection Act (FDPPA) and General Statute 20-43.1. the FDPPA and GS 2043.1 require that personal information in Division of Motor Vehicles records, by closed to the public. Personal information from these records maybe released to individuals or organizations that qualify under one of the fourteen (14) exceptions listed on the attachment. These exceptions are summarized statements of permissible users.

Personal Information

First Name *

Middle Name

Last Name *

DL# *

STATE OF DL# *

CDL * pick one!

YES NO

Cell Phone *

Email *

MAILING ADDRESS *

your present address

Country

Social Security No. *

Date of Birth * 📅

ALIAS / MAIDEN NAME

In connection with this request, I authorize all corporations, credit agencies, educational institutions, law enforcement agencies, city, state, county and federal courts and military services to relies information about my employment, consumer credit history, driving record, criminal record, workers compensation, drug and alcohol information and general public history to SNR SOLUTIONS INC. or consumer reporting agency. This for releases the aforesaid companies from any liability and responsibility from collecting the above information. This form also acknowledges the applicant will be send for Pre-employment drug testing. Also, by signing this form, you are granting the company access to your personal information (Driver license information) under exception number 1.913.14 of the FDPPA and GS 20-43.1

Name of Company/Agency *

✍️ Signature of Applicant

* Please sign here

I agree to the terms and conditions

Type your Full Name *

Date * Select Date

My signature on this document acknowledges that I understand that improper release of information and/or false representation to gain information from the DMV's records is prohibited and its subject to civil action