About MHC
Administrative Offices
Driver’s License Check Consent Form
MARS HILL COLLEGE
(PLEASE PRINT CLEARLY)
DATE: ________________________ __________ or ____________
New Driver Driver Update
(Mr/Mrs/Miss/Ms) _______________________/_______________________/______________________
(First Name) (Middle Name) (Last Name)
DATE of BIRTH: _______/________/_________ Male: __________ Female: ___________
Month Day Year
DRIVER’S LICENSE #: ___________________________ STATE: ________
EXPIRATION DATE: _________/________/___________
Month Day Year
DEPARTMENT: _________________________________ PHONE #: _____________________
NO ONE UNDER THE AGE OF 21 IS ALLOW TO DRIVE A 15 PASSENGER VAN.
_____________ FACULTY ______________ STAFF _______________ STUDENT
*Type of Vehicle to be Driving/Expected Driving Duties:______________________________________
______________________________________________________________________________________
______________________________________________________________________________________
I do hereby consent to having my current driving record checked and the information obtained subject to periodic review by the appropriate college and insurance company personnel, I understand that such information is to be used to substantiate a satisfactory driving record required to drive college motor vehicles or those operated in support of college sanctioned activities.
________________________________________________ _________________________
SIGNATURE: DATE:
We will also need a copy of your personal insurance card.
INSURANCE RESPONSE: ___________ APPROVED: __________ NOT APPROVED: ________
PENDING:____________________________________________________________________________
______________________________________________________________________________________