loading
unknown
The University of Alabama
Motor Vehicle Record (MVR) Release Form
high_risk Check Box
Is driver high risk?
Relationship
Other
Other
Driver's Full Name*
Driver's First Name
Driver's Middle Name
Driver's Last Name
Driver's CWID:
Driver's CWID
* As it appears on Driver's License
Driver's Date of Birth:
Driver's Date of Birth
Type a date/Select a date
...
Driver's Email Address:
Driver's Email Address
Driver's License Number (Not Tag Number):
Driver's License Number
State of Issuance:
* If licensed in the current state for less than 3 years, provide prior license number and state of issuance.
Please provide the approximate date and a brief description of any accidents where you were the driver of an involved vehicle and another driver was determined to be at-fault.
accidents Text Area
Type a description
Certify Check Box
By checking this box, I indicate my understanding of the information shown on this form, and it is my intent to sign the record. I certify that I am the individual stated and my answers are complete and correct.
Department Information
Department:
Manager/Supervisor:
Manager/Supervisor
Lookup
Phone Number:
contact_phone Text Box
Campus - P.O. Box:
contact_campus_box Text Box
Manager/Supervisor/Contact Email Address:
Manager/Supervisor/Contact Email Address
Within 30 days of being approved, all drivers must complete the General Driver Safety Training course. The course can be found on the Risk Management website (
riskmanagement.ua.edu
).
Any driver that may operate a van with a capacity of 9 or more (including driver) must take an online safety training course. Contact
Zachary Dutton
to obtain the online access information.
ftbComments
Type a comment
History
Collapse
Selected Filter:
Configure a new filter
Quick Search:
Apply quick search
Name
Decision
Comments
Date Actioned
No items to display
Submit
Save
Close
Order MVR