Series 403.3.1.1.1P - 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