MOTOR VEHICLE RECORD EVALUATION REQUEST
Employee
Student Worker
PLEASE PRINT CLEARLY or TYPE Submit form in person or via fax only
Driver’s Full Name (include middle name)
State
Driver’s License Number
Date of Birth (mm/dd/yyyy)
People Soft/Employee ID# (if applicable) Departmental Business Contact Name and
Phone #
Name of Department and Department ID Code #
Departmental Business Contact’s E-mail Address
(results will be emailed to Business Contact)
Per University of Houston MAPP 06.05.03, motor vehicle records (MVR’s) are required by anyone authorized to operate a
university owned or leased vehicle. No employee, potential employee, student, or volunteer is permitted to operate a
vehicle on university business until authorization has been approved.
Instructions:
Complete the top portion of this form. The driver must sign and date below. Normal turnaround for
Texas motor vehicle
records is five (5) days. The form must be submitted by the MVR College/Department Contact.
This form contains Level 1 data. Per policy SAM 07.A.08, it may not be emailed unless it is encrypted. To receive a
digital certificate necessary to send encrypted email, please contact UIT Security
NON-TEXAS (OUT-OF-STATE) Driver Licenses - Pre-Employment ONLY
Complete the top portion of this form. Clearly indicate the name of the state and the full driver license number. New
residents moving to Texas who have a valid driver license from another state have 90 days after entry into the state to
secure a Texas Driver License. Out-of-state motor vehicle records incur a nominal fee (approximately $10-$15) which
must be paid by the requesting department.
Signature Authorization:
I
hereby authorize the University to obtain a motor vehicle record as set forth above. This authorization shall remain in
effect over the course of my employment.
Driver Signature (Authorizing Texas or Out-of-State MVR Check)
Date
Non-Texas (Out-of-State) Requests – PeopleSoft LOCAL Cost Center
Fund Code Dept ID Program Project ID Speedtype
Certifying Signature - Print Name and Sign
UHRM REV. 5/19
University of Houston
Office of Risk Management
E. Cullen Building, Room 22
Houston, TX 77204-2009
Offi
ce: 713-
7
43-6772
Fax: (713) 743-1501
*Do not
submit via email unless
encrypted*
Pre-Employment
Volunteer Student
