JOB OPPORTUNITIES

Motor Vehicle Record Disclosure and Release Form

In connection with my on-going employment or my application for employment, should I have or secure a position with Parking Lot Services Inc. and V&V Line Striping. I understand that a Motor Vehicle Record (MVR) which contains public record information may be requested. I further understand that such reports will contain personal information and public record information concerning my driving record from federal, state and other agencies that maintain such records, as well as independent services that provide driving record information.

I authorize without reservation, any party or agency contact to furnish the above mentioned information to Parking Lot Services, Inc. and V&V Line Striping, or the insurance carrier or its agent, Arthur J. Gallagher & Co.

I hereby authorize procurement of my motor vehicle report. If hired, this authorization shall remain on file and shall serve as ongoing authorization for you to procure such reports at any time during my employment. Parking Lot Services, Inc. and V&V line Striping, or their commercial auto insurer and agent will also use this information in conjunction with loss control and safety review efforts.