application
MVR REQUEST AUTHORIZATION FORM

Employer

Premier Parking Enterprises, LLC
PO Box 134
Wyckoff, NJ 07481

Employee/Contractor Name

I give authorization for an abstract of my driving record which accurately reflects information contained in the records maintained by either the New Jersey Division of Motor Vehicles or whichever state my license is presently issued, to be released to my employer.

Address
Driver’s License Number State Issued
Date of Birth
Signature Date