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2. All employees and volunteers who drive a City owned/leased vehicle or private vehicle on official City business must complete this form. Employees and volunteers who possess a driver’s license that is not issued by the State of Maryland must submit with this form an original printout of their driving record.
4. The information on this form will be used by the Department of Human Resources in accordance with the City’s Driver’s License Check and Flagging Program. For additional information concerning this program, contact the Department of Human Resources at 240-314-8470.
6. Supervisor will complete all information below and return this form to the Department of Human Resources at City Hall. Please print or type clearly.
8. Name*
9. Date of Birth*
   Date of Birth
10. Phone Number*
12. Driver’s License Number*
    Please do not include dashes
13. State Issued*
14. Today's Date*
    Today's Date
16. Status*
    -- Select One --EmployeeTemporaryVolunteer
17. Department*
18. Supervisor's Name*
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field