MVR – Motor Vehicle Records Total Effects Inc. MVR – Motor Vehicle Records AFFIDAVIT OF INTENDED USE THIS FORM IS REQUIRED FOR OBTAINING YOUR MOTOR VEHICLE RECORDS. PLEASE COMPLETE THIS FORM ENTIRELY AND SIGN IT/DATE IT. PART A: TO BE COMPLETED BY THE DRIVERName* First Name Last Name Email Address* Phone Number*CDL-A experience*None1-5 Months6 Months - 1 Year1-2 Years2-5 Years5+ YearsDriver Work History1: Start-End Month/Year* 1: Company Name* 1: Truck & Trailer Type* 2: Start-End Month/Year 2: Company Name 2: Truck & Trailer Type 3: Start-End Month/Year 3: Company Name 3: Truck & Trailer Type 4: Start-End Month/Year 4: Company Name 4: Truck & Trailer Type 5: Start-End Month/Year 5: Company Name 5: Truck & Trailer Type 6: Start-End Month/Year 6: Company Name 6: Truck & Trailer Type 7: Start-End Month/Year 7: Company Name 7: Truck & Trailer Type Additional information about Driver Work history:Any Moving Violations (Tickets) in the past 3 years?*Date of birth:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CDL Number:* CDL State:* CDL Expiration:* MM slash DD slash YYYY SSN #* Upload CDL-A photo*Accepted file types: jpg, png, , Max. file size: 5 MB.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:SELECT THE PURPOSE(S)* 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 vehicle 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.HiddenToday's date MM slash DD slash YYYY HiddenIp Address NameThis field is for validation purposes and should be left unchanged.