Motor Vehicle Record Authorization

This form authorizes LTP – Fleet Services to conduct a motor vehicle record check to verify eligibility to operate U-M vehicle.

For current faculty, staff or students (with a uniqname). Use this online system to authorize.

Requestor status at U-M

Pre-employment Contract employee Special Situation (define in the line below)

Requestor Information

Full name (first, middle, last). Name as it appears on driver's license.

Address

City, State, Zip Code

Issuing State/US Territory/Province/Country

Drivers license number

Date of birth

License expiration date

Authorization

I certify that the information provided is accurate and will be used to conduct a motor vehicle record check to verify my eligibility to operate U-M vehicles.

I acknowledge that personal use of a U-M vehicle is strictly prohibited, may not be covered by U-M liability coverage, and could result in a personal liability to me.

I authorize University of Michigan (U-M) Logistics, Transportation & Parking (LT&P) to request from the issuing authority a copy of my motor vehicle record. I acknowledge that a good driving record is part of the U-M vehicle operating policy and a condition of continued permission to operate U-M vehicles. I authorize any fees associated with this request to be billed to the provided department shortcode by service unit billing.

Department Information

Department

Shortcode ( required if drivers license issuing state is not Michigan )

Department contact name

Contact phone

Contact Email