Form DMV07-71 "Request for National Driver Register File Check on Current or Prospective Employee" - Nebraska

What Is Form DMV07-71?

This is a legal form that was released by the Nebraska Department of Motor Vehicles - a government authority operating within Nebraska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2000;
  • The latest edition provided by the Nebraska Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DMV07-71 by clicking the link below or browse more documents and templates provided by the Nebraska Department of Motor Vehicles.

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Download Form DMV07-71 "Request for National Driver Register File Check on Current or Prospective Employee" - Nebraska

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Request for National Driver Register File Check on Current or Prospective Employee
Current or Prospective Employer to Receive the NDR Search Results
:
Driver Employer
Railroad
(A $2.00 fee is required to accompany this request.)
Air Carrier
Engineer
Employer or Agency Name
To the specific attention of:
Business Telephone
Area Code
Number
(
)
Mailing Address (Number and Street)
City, State and Zip Code
Type or Print Plainly (Avoid delays. Inquiries that cannot be read will not be processed.)
Driver's Full Legal Name (Last, First, Middle)
Driver License Number and State
Month, Day, and Year of Birth
Social Security Number
Sex
Color of Eyes
Height
Weight
Other Names Used (Maiden, Prior Name, Nickname, Professional Name, Other)
Mailing Address (Number and Street with Apartment Number if any or Rural Route/Carrier and Box Number)
City, State and Zip Code
EMPLOYEE UNDERSTANDING: I understand that the National Driver Register (NDR) search will result in a printed report which will be sent
only to the employer or regulatory agency listed above on this form. The report will indicate either (1) that the NDR does not contain a record
matching my identification or (2) that the NDR has a probable identification (match) from one state (or more) which will be named on the report. A
separate check of state files would be required (1) to verify the identification or (2) to obtain the driving record. It is the responsibility of the listed
employer to obtain the state driver records and to determine or verify records which apply to me. Under the Privacy Act, I have the right to request
record(s) pertaining to me from the NDR. I also understand that if convictions, suspensions or revocations of mine are found which I have not shown
on my applications or interviews, I might not be hired as a driver or could lose my job as a driver, and the State where I am licensed may also take
action on my driver license including suspension, cancellation, or revocation. I hereby, with my signature, authorize a one-time file search of the
NDR and any resulting reports to be sent to the employer or agency named on this form.
Driver's Signature (Please read information on back before signing.)
Date
NOTARIZATION
Official Use Only
Required only if the NDR File Check Request is not made in
person by the current or prospective operator.
Date Received
Date Sent
Internal Control
Sworn to and ascribed before me
Notary Public
Seal or Stamp
this _______ day of ___________
TYPE OF IDENTIFICATION (U.S. Based):
Photo Driver's License or
Permit
20_________ in the city/county of
NE ID Card (issued after 1-1-90)
Certified Birth Certificate
Passport
Valid Military ID (DD214) or Discharge Papers
INS Documents:I-551, I-94,
____________________________
I-688,I-688A, I-688B
Other (specify)
________________________________
State of _____________________
Employee Verifying Applicant Identification (Signature)
Date
Form DMV 07-71; Rev 1/2000
See Reverse Side for Additional Explanations
Request for National Driver Register File Check on Current or Prospective Employee
Current or Prospective Employer to Receive the NDR Search Results
:
Driver Employer
Railroad
(A $2.00 fee is required to accompany this request.)
Air Carrier
Engineer
Employer or Agency Name
To the specific attention of:
Business Telephone
Area Code
Number
(
)
Mailing Address (Number and Street)
City, State and Zip Code
Type or Print Plainly (Avoid delays. Inquiries that cannot be read will not be processed.)
Driver's Full Legal Name (Last, First, Middle)
Driver License Number and State
Month, Day, and Year of Birth
Social Security Number
Sex
Color of Eyes
Height
Weight
Other Names Used (Maiden, Prior Name, Nickname, Professional Name, Other)
Mailing Address (Number and Street with Apartment Number if any or Rural Route/Carrier and Box Number)
City, State and Zip Code
EMPLOYEE UNDERSTANDING: I understand that the National Driver Register (NDR) search will result in a printed report which will be sent
only to the employer or regulatory agency listed above on this form. The report will indicate either (1) that the NDR does not contain a record
matching my identification or (2) that the NDR has a probable identification (match) from one state (or more) which will be named on the report. A
separate check of state files would be required (1) to verify the identification or (2) to obtain the driving record. It is the responsibility of the listed
employer to obtain the state driver records and to determine or verify records which apply to me. Under the Privacy Act, I have the right to request
record(s) pertaining to me from the NDR. I also understand that if convictions, suspensions or revocations of mine are found which I have not shown
on my applications or interviews, I might not be hired as a driver or could lose my job as a driver, and the State where I am licensed may also take
action on my driver license including suspension, cancellation, or revocation. I hereby, with my signature, authorize a one-time file search of the
NDR and any resulting reports to be sent to the employer or agency named on this form.
Driver's Signature (Please read information on back before signing.)
Date
NOTARIZATION
Official Use Only
Required only if the NDR File Check Request is not made in
person by the current or prospective operator.
Date Received
Date Sent
Internal Control
Sworn to and ascribed before me
Notary Public
Seal or Stamp
this _______ day of ___________
TYPE OF IDENTIFICATION (U.S. Based):
Photo Driver's License or
Permit
20_________ in the city/county of
NE ID Card (issued after 1-1-90)
Certified Birth Certificate
Passport
Valid Military ID (DD214) or Discharge Papers
INS Documents:I-551, I-94,
____________________________
I-688,I-688A, I-688B
Other (specify)
________________________________
State of _____________________
Employee Verifying Applicant Identification (Signature)
Date
Form DMV 07-71; Rev 1/2000
See Reverse Side for Additional Explanations
Requests for National Driver Register (NDR) Record Checks
Who May Obtain an NDR Record Check
1) Any person may ask to know whether there is an NDR record on him or her and may obtain a copy of the
record if one exists. Requests from individuals require Form DMV 07-70. Form DMV 07-70 can be obtained from the
Department of Motor Vehicles; however, all Individual Requests must be mailed directly to the National Driver
Register.
Do not mail Individual Request Forms to the Department of Motor Vehicles.
2) Employers of drivers, locomotive engineers and air carriers may also obtain NDR record checks. Every
driver, operator or pilot on whom an NDR file check is requested is entitled to review the NDR report(s) provided to
the employer. The results of the NDR check will be mailed only to the current or prospective employer or third party
service provider. If no employer is named on the form or it is changed, the request will not be processed.
The following authorization applies to Railroad Company Requests
NDR C
A
:
The U. S. Department of Transportation, Federal Railroad Administration, in
HECK
UTHORIZATION
accordance with 49 CFR, Part 240.111, requires that I hereby request and authorize the National Highway Traffic
Safety Administration (NHTSA) to perform an NDR check of my driving record for a 36-month period prior to the date
of this request including license withdrawal actions open at time of file check. I hereby authorize the NDR to furnish a
copy of the results of this NDR check directly to the railroad company identified on this inquiry form.
Notice to Prospective Air Carrier Employees
Pursuant to Section 502 of the Pilot Records Improvement Act of 1996, this serves as notice of a request for NDR
information concerning your motor vehicle driving record and your right to receive a copy of such information.
What NDR Records Contain
NDR results for employers will contain only the identification of the state(s) which have reported information
on the driver to the NDR and only information reported within the past 3 years from the date of the inquiry. Driver
control actions initiated prior to that time, even if still in effect, will not be included.
Detailed information to confirm identity or to describe the contents of the driver record can be obtained only
from the State(s) listed when probable matches are reported. The name and address of the driver licensing official will
be provided for each state listed.
How to Request an NDR Record Check
Using this form (DMV 07-71), which may be completed by either the current or prospective employer or the
current or prospective employee, (1) the driver must authorize the request by his or her signature or mark as witnessed
and (2) the driver must certify his or her identity.
Any mailed NDR record check request must be notarized to certify identity. Requests made in person require
certification of identity acceptable to the state through one or more documents issued by a recognized organization (e.g.,
a driver's license or a certified birth certificate) which contains a means of verification such as a photograph or a
signature.
Completed form DMV 07-71 should be returned, along with a check or money order in the amount of
$2.00, to the address listed below:
Department of Motor Vehicles
Driver and Vehicle Records Division
301 Centennial Mall South
Box 94789
Lincoln, Nebraska 68509-4789
Requests can only be processed for the employer if the employee holds a Nebraska Driver's License or if the
employee is domiciled in Nebraska and does not hold a driver's license. If the employee holds an out-of-state license,
requests must be processed thru the employee's state of license.
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