ࡱ> DFC[ Cbjbj  Apa!\pa!\& (((((<<<8t<EEE}$ p#(E#"EEE((gE^((}E}TRi0#x##(EEEEEEEmxEEEEEEE#EEEEEEEEE > :  AUTHORIZATION TO OBTAIN DRIVER HISTORY By my signature below, I consent to the release of my driver record prepared by a consumer reporting agency, such as HireRight, Inc., or the Department of Motor Vehicles, to 91 (the Company), and its designated representatives and agents. I authorize the Department of Motor Vehicles in any state in which I may have been licensed to furnish any and all information on my driver history that is requested. I understand that if the Company hires me, my consent will apply, and the Company may obtain reports throughout my employment, as long as I am required to drive on Regent business. I certify the information I provided on this form is true and correct. I agree that this Authorization Form in original, faxed, photocopied or electronic (including electronically signed) form will be valid for any driver history reports that may be requested by or on behalf of the Company. Supervisor Name _______________________________________________________________________ Department ___________________________________________________________________________ Applicant Last Name _______________________ First _________________ Middle _____________ Applicant Signature ____________________________________ Date State ___VIRGINIA__________________________________________________________________ Drivers License # _____________________________________________ IF YOU HAVE NOT HELD A DRIVERS LICENSE IN THE STATE OF VIRGINIA FOR AT LEAST THE PAST THREE YEARS, LIST ADDITIONAL INFORMATION BELOW: Social Security # _______________________________ Date of Birth _______________________ Present Address ____________________________________________________________________ City/State/Zip _____________________________________________________________________ Previous Drivers License # ____________________________________ State______________ Previous Drivers License # ____________________________________ State ______________     PAGE  -.br< ] T d s Ҹym`Qh-sdh-sdCJOJQJaJh5CJOJQJaJhBCJOJQJaJhxGCJOJQJaJh&2hJ.CJOJQJaJhCJOJQJaJhJ.CJOJQJaJhCJOJQJaJh&2hCJOJQJaJhJ.5>*CJaJh&2h5>*CJaJhb5CJ\aJ(jhb5CJU\aJmHnHu.// 0 b c  $ !da$gd_$a$gd $xa$gd$x7$8$@&H$a$gd $7$8$H$a$gd  B N R W \ h  "/;Otuv{!"%&ƻ}yunununyjyuyc hTFhbhe hTFh_h_hb h 156 h_56 hb56hbhb56h*CJaJhzS CJaJh&2hCJaJh-sdh-sdCJOJQJaJh-sdCJOJQJaJ# W tu&{&()+,./12; &`#$gdgdhgd_ 7$8$H$gdX $ xddxa$gd_$ xddx]a$gd_&')*,-/0239:;ABC hTFhbh h0Jjh0JUhiUjhiUU;<=>?_$$岹$ɾɾ岹$< 00&P/R :pa$/ =!"#$`%  n#kVEbApPNG  IHDRkgAMAPLTEٟ pHYs\A\>w IDATxݽHvpXn:`si ߟh5Ula/  ;򪭀nRs|`=zŊ&e?SEqj|sXy؝=YM+ I Ckf^.lַ//̐zq+.)/L/2n]h>̷]"+@@}wvL{ X5x#lJQFGb13("uẌ́q*3HFFǪnwCKbmv;A_It gu#elт.v 6;|q5#+bXKb%DL$y7S1EђM8&$K@ Dұ|cE1AU&R>#YSqyZW2Ramf Ӛy"gEtEE,bDSY-.^U5bW (ͤ#"5-JB/$8̋-43HJGQd%Wm.u\5PcW,FkXwY$p'Y!vhz%|eBX"+uN kl|N!bU_|-E:i"▜4+EUTE.NqWXax }X:@eUXaE谲kAp:dpÊLbi 泑v9*Hy|M̬԰Lxd9vX_,x :Vi3J%[ì a3ȴf='{MSx燮Sn_7u XRy 41^:sDp~8~=KF)dXr=ͮ^|ϺϫRU=yV>:^&"ޱNgUˢHvMԢsz͒OQ,uʮ\Ϯ4+;7k[7.K kԋ"o O:OVԁmo_w+^{JؙY|c;?o\몲ѰH'۳윬&ٴ9i^\?)#ez?K臇YѬB.ӞM~F?ba `Mq6KAX:,X8IC#>+YqY@d)~fɪe锢¿[WEqxp,K_Ȣ.s3U0Vg8YHjFh!?USNPoDZe1ˏ,3K2]U,x/jr2#*jR{9PwLq: Y9"ﲦ,8ZpYbl:,[Ke"Na룩\2RKEgr*B,4x5~ˢ:iVe!aٷ?@j HZٷQc+},Ket#vE +7wYɬyV ,o㱨'wo"9)\â9v- t]cY.>A곾8 f5{7v%\4ﱒ%b5cWQƶT.hȺx0k,:g'daϪ0:e>' BQ}GmXo=5֣)ja9Vu9-++,S)8òwXԆY S,xKg}:Nf[ւ,( Xi,U +_wXԫ+3;V uѬ֬ur&mX&4G&` *EcMw,Y*CVUw*RvY+ +:b'Q,=֍T MCV CTVY*pyW=ͅ-KfqfA \+Vz4X fՖWzM~ص4"eIsfE0p=kj`\'a계axXD>`aX鎵-E}.+HUu*rXn9YkŲWĒY̲pZ^ h GT(W,YK/ `0>XWfX"z,(;EvبGR9|Xu~dDVcYI9`˄cY"|oj77DVfkfͪd0 o<֫VNW,ֲ),Znq+uYon|f6ZDmwYaX-Bѷ Y3 YvL@ғXŊANvMž [ MyKcYPeRx*_. )aްY_3}JaEsJ!Do{MX$z~k,!K<5D83w[ݩ돿TewmCVA'{Zf ) HT &{7l ](֟ Y7Np-KPֺa8AKwke*Ŗu81a؛"fYWUheͦh$w[&RK Ζm[y7_c0RkBN4kÿZƱԔ{Xɬ\)O|׼fq̫s01̊s,l}jBJjҐXc'v27KEu|i Xc*,u,vY*̟‚֬Z?+^FeksR~'KcYK.j_csMfj 8E6 vb}VgEd593K>]WZ,Sث%lSYv8,Od1 )>7ď_؆ oNUDk,+=ݫS|C<fڧenI0$ J0(&ΪNbY.EDʐej7Ng'*j؉b}Z X C}C<2AX\lYYˊ, dzn4SCFIom$Jcٿ" YLeq?cX`~1YOjdxJu3^VTl_{؀2%\Z!X X7ȑtu池\cYa I֚'D`߶Q XaA?Z[dv/_`M}VAVXưHP]kjVJ!,7cr>j#k.Ʊ=X>Δ;ղŲn-z,爕$'x>߷ɳ<`x*wY:lV b%"o)C\oX;qo%U c-`j3;Ԝ֛Bduz),%b;yZȷ,KD.K>-MYXaD0`{Y \ìΰT e-[L |5ٴKX;`aB%!+e-+6' XvzZh_Daa 6dI+ZSf,za~) D0`1X)D¾ne!kee=pUc-KdY3Fvx3r@s kX* Y+jl`dTz*:u%wX횑Q1,LC3v4GW{6 5D(҇]ۏ+ONb֏b#d!m'7!"^nk1&tXj(YU4k)ީٔ{:BVo_3BM4iY7u[W UhL.bj\լMeKaߟdQgXX{RE;Â|uEr/ @݈(ذD"-;csvV ,Ճ鷆 Y^oYPddp4!8jdVjXQS \[='k/juXzRQP"Xb%p1ev7܏gq곈aA"oeՂn͏RjH H!4ÜvW#jK,b,XĚf$'{`ťϊ ?kH~ue¶}řf"KoM_zNc;u޲R? 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