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Authorization for Review of Motor Vehicle Record

1. The University of Vermont requires that all drivers of UVM owned, leased, or rented vehicles must be 19 years old and hold a valid U.S. or Canadian license. All drivers for whom driving is an essential function of their job or for whom a vehicle is regularly furnished, and all drivers of passenger vans must attend UVM Risk Management's Driver Training and have their motor vehicle record checked BEFORE being authorized to drive. Additionally, UVM requires satisfactory initial and on-going motor vehicle record reviews to be granted and maintain eligibility for driving privileges.

In connection with your application for driving privileges at the University of Vermont, you understand that motor vehicle records will be requested for the purpose of obtaining and reviewing your driving record from any state in which you have been licensed in the last three years.

Additionally, if you are approved to drive UVM vehicles and the status of your motor vehicles record changes at any point in time to reflect the violations listed below, you will notify the Department of Risk Management & Safety and discontinue driving UVM vehicles immediately until approval is re-instated.

Any of the following violations within the last three years on your motor vehicle record render you ineligible to drive a University vehicle for three years from the date of violation:

DWI
Driving under the influence
Negligent homicide
Operating with a suspended license
Using a motor vehicle for commission of a felony
Aggravated assault with a motor vehicle
Operating a motor vehicle without the owner's consent
Permitting an unlicensed driver to drive
Reckless or careless and negligent driving
Hit and Run or leaving the scene of an accident with injury or death resulting, or property damage in excess of $1,000.
A combined total of three citations in two years of moving violations, at-fault accidents or any other UVM driving policy

Please read and answer each of the following statements to begin the application process:

Yes, I agree No, I retract my request

I understand that I am required to read and comply with all UVM driving policies found at https://www.uvm.edu/sites/default/files/UVM-Policies/policies/driversafety.pdf and that disregard for driving policies may result in loss of driving privileges.

I understand that use of UVM owned or leased vehicles for non-university related business may result in personal liability.

I understand that I have the right to retract my authorization for UVM to review my motor vehicle record and agree to do so in writing to the Department of Risk Management when and if the time comes that I no longer need or desire driving privileges.

2. Please enter the following information as it currently appears on your drivers license. Note this is not asking for a local address if you have an out of state license. Provide your address as it appears on your current license:

First Name & Middle Initial:

Last Name:

Address:

Address 2:

City/Town:

State:

ZIP/Postal Code:

Date of Birth (MM/DD/YYYY):

License Number:

License Expiration Date (MM/DD/YYYY):

3. Please enter the following information if it has changed on your drivers license at any point in the last three years.

Name:

Address:

Address 2:

City/Town:

State:

ZIP/Postal Code:

Country:

List any name change in the last three years:

List any other state in which you were licensed
in the last three years:

4. Please define your affiliation with UVM:

Volunteer Supporting Extension Programs
Farmer Training Program | Farmer Training Blackboard name
Other (Please specify)

5. Please enter the following information:

Your EMail Address:

Primary Department for Driving:
Position Title or Group Role:

Your Phone Number:

Your NetID:

State of Furthest Intended Destination
for University Business:

Sponsor Name (Staff or Faculty member):

Sponsor/Supervisor NetID:
What is a netID? | UVM directory

Sponsor/Supervisor EMail Address:

Sponsor/Supervisor Phone:

6. The University of Vermont requests that driving applicants disclose the last three years of their driving violation history. Please indicate below the dates, types and locations of any driving violations that may appear on your motor vehicle record. Be aware that UVM reserves the right to deny driving privileges for applicants that do not fully disclose the last three years of their driving violations.

Year Type of Violation or Collision State where Violation or Collision Occurred

2024

2023

2022

2021

List any additional violations or collisions that are not noted above.

7. By answering "yes" to this question, I authorize the Department of Risk Management on behalf of the University of Vermont to perform an initial three year history review and on-going reviews as necessary of my motor vehicle record (not to pre-date three years from the year of this authorization).

Yes, please review my motor vehicle record history to determine my eligibility for driving privileges of University of Vermont owned and/or leased vehicles.
No, I do not authorize the University of Vermont to review my motor vehicle record and by this refusal retract my request to be considered for driving privileges.

8. I understand that in answering "yes" to this question and submitting my request for authorization of driving privileges by clicking on "done" below I have entered into an agreement with the University of Vermont for on-going driving privileges contingent on my maintaining an acceptable motor vehicle record.

Additionally, I acknowledge that this agreement must be canceled in writing to the Department of Risk Management. I further authorize UVM and/or their designated consumer reporting agency in the ongoing procurement of my driving record at any time during my continued authorization for driving UVM owned or leased vehicles.

Until such time that I cancel this request, PLEASE REVIEW MY MOTOR VEHICLE RECORD BEGINNING WITH A THREE YEAR HISTORY FROM TODAY'S DATE FOR THE PURPOSE OF ASSESSING MY ELEGIBILITY FOR DRIVING PRIVILEGES WITH THE UNIVERSITY OF VERMONT.

For California, Minnesota or Oklahoma applicants only, I understand that I will receive a copy of any driving record report obtained by the University of Vermont pursuant of this agreement.

Yes, Complete My Request
No, Cancel My Request

	Yes, I agree	No, I retract my request
I understand that I am required to read and comply with all UVM driving policies found at https://www.uvm.edu/sites/default/files/UVM-Policies/policies/driversafety.pdf and that disregard for driving policies may result in loss of driving privileges.

I understand that use of UVM owned or leased vehicles for non-university related business may result in personal liability.

I understand that I have the right to retract my authorization for UVM to review my motor vehicle record and agree to do so in writing to the Department of Risk Management when and if the time comes that I no longer need or desire driving privileges.

First Name & Middle Initial:
Last Name:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Date of Birth (MM/DD/YYYY):
License Number:
License Expiration Date (MM/DD/YYYY):

Name:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Country:
List any name change in the last three years:
List any other state in which you were licensed in the last three years:

Your EMail Address:
Primary Department for Driving:
Position Title or Group Role:
Your Phone Number:
Your NetID:
State of Furthest Intended Destination for University Business:
Sponsor Name (Staff or Faculty member):
Sponsor/Supervisor NetID: What is a netID? \| UVM directory
Sponsor/Supervisor EMail Address:
Sponsor/Supervisor Phone:

Year	Type of Violation or Collision	State where Violation or Collision Occurred
2024
2023
2022
2021