MVR Consent Form

Please read the consent below in full, then complete and sign the form to authorize LUX Freight Lines to obtain your Motor Vehicle Record (MVR).

Appendix A — LUX Freight Lines

I have reviewed information in LUX Freight Lines's vehicle safety policy. I understand that it is my responsibility to operate company vehicles safely and follow the requirements of the company vehicle safety policy. I also understand that the company will periodically review my motor vehicle record (MVR) and assess my eligibility to drive a motor vehicle on company business.

I authorize LUX Freight Lines to obtain my MVR. This authorization remains valid as long as I am an employee or employee candidate and may only be rescinded in writing.

Employee Name (Print)

Driver's License Number

State Issued

Date

Employee Signature (draw with your finger, stylus, or mouse)

Sign here

Your drawn signature above, together with your printed name and date, constitutes your electronic signature on this MVR Consent Form.

Please sign above before submitting.

For Office Use Only

Reviewer Signature

Date