Driver Record Request

I authorize Eastern Oregon University to receive a copy of my driving
record from the appropriate DMV so that I can be authorized to use the
motor pool vehicles and/or the EOU fleet vehicles. This driving record
check will be good for two years from the date received. The department
that is requesting & providing the index will be responsible for the cost
of the driving record check, cost varies depending on the state.

Employee/Student

First Name:

As it appears on your Driver's License.

Last Name:

Date of Birth:

Driver License Number:

State of Issue:

Issue Date:

Expiration Date:

Class of License:

Camera ID:

DPS Audit Number:

SSN #:

Gender:

Weight:

M.I.:

Signature:

Phone #:

EOU Email:

Department Manager/Supervisor

Department Requesting Record:

Department Supervisor Name:

Supervisor Email:

Index number to be charged:

Please type a valid Index/Account #, failure to do so request won't be processed.

**It takes at least 10 working days to receive records from Oregon's DMV.
Other states can take up to six to eight weeks.

Contact Information