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NON-ARIZONA DRIVER’S LICENSE REQUEST FORM
Date:
Department Name:
Requester:
Department Purchasing Credit Card Number and Expiration Date:
Full Name of Person for Request:
Date of Birth:
Driver’s License Number:
Issuing State:
Per the Authorized Driver Policy and Procedures, NAU reviews and evaluates the Motor Vehicle Record
(MVR) from the last 39 months for all persons authorized to drive on university business. For those
individuals who have been licensed outside of Arizona during the past 39 months, it is necessary to obtain
their MVR from other states where they have been licensed. Faculty, Appointed Personnel, Service
Professionals and Classified Staff must have an AZ Driver’s License per Arizona State Law (ARS 282001.1b).
Employed students with out-of-state driver’s licenses who are considered “Authorized Drivers” must
obtain their MVR record from the previous 39 months. The department requesting the MVR check shall
complete this form and submit it directly to American Background. American Background is the vendor
responsible for obtaining MVR’s from other states. Upon completion of this form, it must be signed by
the person whom the MVR is being requested and faxed directly to American Background at 1-866-3901627. Once the MVR check is completed, the results will be sent directly to Capital Assets and Services
ATTN: Director of Operations for review. If the results of the MVR are “acceptable,” then the requesting
department will not be notified. However, if the results of the MVR come back either “conditional” or
“high risk,” then the requesting department will be notified of the results in writing. The department
submitting the MVR request is responsible for the costs.
If the out of state MVR request is for the following states; Washington, New Hampshire, Alaska,
Pennsylvania, Canada or Puerto Rico, then a separate release form must be obtained and signed by the
individual whom the MVR check is being requested. These release forms can be obtained by contacting
the Director of Operations at Capital Assets and Services at 928-523-6434.
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Generally, international driving records outside the United States are not available for purposes of MVR
review. If your department needs to authorize an individual new to the United States to drive on
university business, contact the Director of Operations at Capital Assets and Services at 928-523-6434.
If you have additional questions about the MVR review, please contact the Director of Operations at
Capital Assets and Services at 928-523-6434.
I hereby authorize Northern Arizona University, its employees, and its authorized agents and
representatives (including American Background) to verify all information contained in this form and
to inquire into my driving record. I hereby release the university, its employees, its authorized agents
and representatives, and all others involved in this inquiry from any liability in connection with any
information they give or gather and any decisions made based on such information. I understand that
my ability to drive on university business is contingent upon the successful completion of the inquiry. I
further understand that I have a right, under Section 606(b) of the Fair Credit Reporting Act, to make a
written request to the university within a reasonable period of time for a complete and accurate
disclosure of the nature and scope of the investigation requested, and for a written summary of rights
pursuant to section 609(c) of the FCRA.
________________________________________
________________________
Printed Name of Person MVR is being Requested
Date
________________________________________
Signature
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