Apply Online – Driving Record Verification

Driving Record Verification

  • Section 1: To be completed by authorized human resources staff

  • I hereby request the Department of Motor Vehicle to release to VNA & Hospice of the Southwest Region information involving the individual listed below in Section 2. I certify that this individual is a current employee of this company or has been given a conditional offer of employment. I understand this information is only for the purposes of offering employment and agree it shall be otherwise kept confidential.
  • Section 2: To be completed by applicant: Consent from current or prospective employee

  • I currently possess a valid driver’s license. I have not received a conviction violation or involvement in an accident, nor have I had my license suspended at any time during the past three years, other than the following:
  • I hereby authorize the Department of Motor vehicles to release to VNA & Hospice of the Southwest Region any information relating to my driving record. I certify that I am currently employed by the above named company or have been given a conditional offer of employment by the company.
  • This field is for validation purposes and should be left unchanged.