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Series 403. - Authorization of Driver's License Check

Adopted: November 1980
Revised: January 2004


Directions:  Complete and return to  Transportation Department

Independent School District 196

15180 Canada Avenue

Rosemount, MN  55068

I hereby authorize Independent School District 196 to check my driving record. 

This check is being done in consideration of:  (check the appropriate response)

               My possible employment as a bus driver for District 196, or

               The possibility of my driving a vehicle as part of my employment

              with District 196.

                        I am currently employed at                                                    


___________________________________           ___________________________________

                 Print full name                                                     Signature


___________________________________           ___________________________________

           Driver’s license number                                                  Date