Motor Pool  - Driver Registration Form

(This form is for Maryland drivers only. All other drivers have to go to their own state's DMV or MVA to get driving records. Please  fill out and submit to the Motor Pool Office).

Full Name: (please print)

First: Middle: Last:
Driver's License Number:  
Date of Birth:
State Issuing License:  Social Security Number:

I agree to allow the Fleet Manager of Salisbury University to obtain a copy of my driving record from the state Motor Vehicle Administration of the state issuing my driver's license now and on an annual basis.  I also agree to notify the fleet manager if my driving record accumulates six or more points for moving violations.

________________________________________
Signature and Date

________________________________________
Department for Which You are Driving

________________________________________
Person to Notify

 

________ Check here if you are currently a student of SU.

________ Check here if you are currently an employee of SU, but not a student.