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THIS FORM IS REQUIRED FOR OBTAINING YOUR MOTOR VEHICLE RECORDS. PLEASE COMPLETE THIS FORM ENTIRELY AND SIGN IT/DATE IT. YOUR MVR WILL BE ACCESSED BY STARCDL
PART A: TO BE COMPLETED BY THE DRIVER
First Name
Last Name
Email
Phone Number
Applying as
Applying as
Company driver
Owner operator
Driving
Driving
Solo
Team
Truck year, make & model
CDL-A flatbed experience
None
0 - 5 Months
6 Months - 1 Year
1 -2 Years
2 - 5 Years
5+ Years
Work history: (previous companies & when)
Violations, accidents or DUIs in the last 3 years
SSN (social security number):
Date of birth
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CDL Number:
CDL State
CDL Expiration:
Upload Driver's License
INFORMATION MAY BE USED ONLY FOR THE FOLLOWING APPROVED DRIVER PRIVACY PROTECTION ACT (DPPA) PURPOSES. SELECT THE PURPOSE(S) FOR WHICH YOU WILL BE ORDERING MVRS:
By a business that will use the information to verify the accuracy of information submitted by individuals for the purposes of preventing fraud, pursuing legal remedies against or recovering a debt or security interest.
By an insurer or insurance support agency in connection with claims, investigations, antifraud activities, rating or underwriting.
By an employer/agent or insurer to obtain or verify information on a Commercial License Holder.
Written consent of the person whose record is being requested (Available in AR, CA, CO, DC, FL, HI, IL, KY, MA MN, NM, NY, ND, RI, VT, VA, WY)
Under the penalty of perjury, I attest that I shall not obtain, resell, transfer, or use the information in any manner prohibited by law. I understand that motor vehicles or driver records that are obtained, resold, or transferred for purposes prohibited by law may subject me to civil penalties under federal and state law.
Today's date
Signature
❌
By clicking the submit button, I agree to the terms and conditions *
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