Driving History Questionnaire and DMV Check

Driving Motor Vehicle Check Form

Form to attest to driving violations and authorize DMV check.

  • Please type full name not just an initial. If you do not legally have a middle name, type “no middle name”
  • Hidden
  • MM slash DD slash YYYY
  • Driving History

  • -Driving under the influence of alcohol or drugs -Refusing to take a substance test -Driving with an open container (alcohol) -Reckless driving or careless driving -Hit and run -Fleeing or evading police or roadblock -Racing speed contest -Driving on a suspended or revoked license -Vehicular assault
  • -Moving violations that include-Speeding, Improper lane change, failure to yield, failure to obey a traffic signal or sign -Accidents -Having a license suspended related to a moving violation
  • MM slash DD slash YYYY