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M <br />sr <br />AUTHORIZATION FOR DRIVER LICENSE CHECK <br />The City of Lino Lakes requires a Driver's License Check for all employees, volunteers, <br />agents of the city, and independent contractors who have direct access to or may operate <br />any vehicle or equipment owned by the City of Lino Lakes. <br />The City of Lino Lakes is of Bring to the undersigned, vehicle or equipment access, <br />subject to positive results of a Drivers License Check. Please complete the below <br />required information authorizing the Lino Lakes Police Department to conduct a review <br />of your driving record. You will be informed of your status when the review is complete. <br />The undersigned will further release the City of Lino lakes and the State of Minnesota <br />from any claims or damages which the undersigned might incur as a result of the police <br />department obtaining this information from the State of Minnesota. <br />This information is being requested by the City of Lino Lakes to determine whether the <br />undersigned is disqualified from operating a city owned vehicle or equipment. Under <br />Minnesota State Law, the City may disqualify a person from access to city owned <br />vehicles or equipment because of, but not limited to, an invalid license, DWI convictions <br />and moving vehicle violations. This information is classified as private personnel data <br />and will be provided only to those employees or agents who have a need to review it. <br />The City of Lino Lakes does not intend to release the information to any other party <br />unless required to do so by subpoena or court order. The undersigned may refuse to <br />authorize the release of this information, but refusal will result in dispmalification from <br />vehicle or equipment access. <br />Name <br />(Last) <br />Date of Birth <br />Sex M <br />(First) (Middle) <br />Driver's License # <br />State of Issuance <br />Signature <br />F <br />Date <br />