INDEPENDENT SCHOOL DISTRICT 196
Rosemount, Minnesota
Educating our students to reach their full potential
Series Number
Title
403.3.1.1.1P
Adopted
November 1980
Revised
January 2004
Authorization of Driver’s License Check
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
Location
____________________________________
Print full name
____________________________________
Signature
____________________________________
Driver’s license number
____________________________________
Date
Procedures/400 Series/403.3.1.1.1P
Graphic Arts/1-27-04