Form LI-15 "Request for National Driver Register File Check on Current or Prospective Employee" - Texas

What Is Form LI-15?

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

Form Details:

  • Released on August 1, 2006;
  • The latest edition provided by the Texas Department of Public Safety;
  • 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 LI-15 by clicking the link below or browse more documents and templates provided by the Texas Department of Public Safety.

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Download Form LI-15 "Request for National Driver Register File Check on Current or Prospective Employee" - Texas

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REQUIRED FEE INFORMATION DETAILED ON REVERSE SIDE OF FORM
TEXAS DEPARTMENT OF PUBLIC SAFETY
Request for National Driver Register File Check on Current or Prospective Employee
TYPE OR PRINT CLEARLY–BLACK INK ONLY (Inquiries that cannot be read will not be processed.)
NDR Search Results to be Received by Current or Prospective Employer of:
(
) Motor Vehicle Operator
(
) Locomotive Railway Operator
(
) Pilot Applicant
Employer or Agency Name
Forward to the specific attention of:
Business Telephone
(
)
Mailing Address (Number and Street)
City, State and Zip Code
Driver’s/Operator’s Full Legal Name
First
Middle
Last
Other Names Used (Maiden, Prior Name, Nickname, Professional Name, Other)
Mailing Address (Number and Street with Apartment Number if any or Rural Route/Carrier & Box #)
Home Telephone (Optional)
(
)
City, State and Zip Code
Work Telephone (Optional)
(
)
Driver License Number and State
Social Security Number (Optional)
Date of Birth (Month, Day, Year)
Sex
Color of Eyes
Height
Weight
M
F
EMPLOYEE UNDERSTANDING: I understand that the National Driver Register (NDR) search will result in a printed report which will be sent only to
the current or prospective employer/regulatory agency listed 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 (pointer record) from one state (or more) which will be named on the
report. A separate check of state files would be required to: (1) verify the identification or (2) obtain the driving record. I understand that under the
Privacy Act, I have the right to request record(s) pertaining to me from the NDR to verify their accuracy. I hereby, with my notarized signature, author-
ize a one-time file search of the NDR and any resulting reports to be sent to the current or prospective employer/regulatory agency named on this
form. (See reverse side for authorization)
Driver/Operator’s Signature (Please read information on back before signing.)
Date
NOTARIZATION
(Required only if the NDR File Check Request is not made in person by the current or prospective operator)
appeared before me and executed this instrument
(Requestor’s Name)
this
day of
,
in the city/county of
(Month)
(Year)
Notary Public
My commission expires
Seal or Stamp
(Notary Public)
FOR DEPARTMENT USE ONLY
Date Received
Date Sent
Other
TYPE OF IDENTIFICATION:
( ) Valid Photo Driver License
( ) State – issued Photo ID
( ) Birth Certificate
( ) Valid Passport
( ) Valid Military ID
( ) Military Discharge Papers
( ) Other (specify)
Employee Verifying Applicant Identification (Print Name)
Signature
LI-15 (8/06)
REQUIRED FEE INFORMATION DETAILED ON REVERSE SIDE OF FORM
TEXAS DEPARTMENT OF PUBLIC SAFETY
Request for National Driver Register File Check on Current or Prospective Employee
TYPE OR PRINT CLEARLY–BLACK INK ONLY (Inquiries that cannot be read will not be processed.)
NDR Search Results to be Received by Current or Prospective Employer of:
(
) Motor Vehicle Operator
(
) Locomotive Railway Operator
(
) Pilot Applicant
Employer or Agency Name
Forward to the specific attention of:
Business Telephone
(
)
Mailing Address (Number and Street)
City, State and Zip Code
Driver’s/Operator’s Full Legal Name
First
Middle
Last
Other Names Used (Maiden, Prior Name, Nickname, Professional Name, Other)
Mailing Address (Number and Street with Apartment Number if any or Rural Route/Carrier & Box #)
Home Telephone (Optional)
(
)
City, State and Zip Code
Work Telephone (Optional)
(
)
Driver License Number and State
Social Security Number (Optional)
Date of Birth (Month, Day, Year)
Sex
Color of Eyes
Height
Weight
M
F
EMPLOYEE UNDERSTANDING: I understand that the National Driver Register (NDR) search will result in a printed report which will be sent only to
the current or prospective employer/regulatory agency listed 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 (pointer record) from one state (or more) which will be named on the
report. A separate check of state files would be required to: (1) verify the identification or (2) obtain the driving record. I understand that under the
Privacy Act, I have the right to request record(s) pertaining to me from the NDR to verify their accuracy. I hereby, with my notarized signature, author-
ize a one-time file search of the NDR and any resulting reports to be sent to the current or prospective employer/regulatory agency named on this
form. (See reverse side for authorization)
Driver/Operator’s Signature (Please read information on back before signing.)
Date
NOTARIZATION
(Required only if the NDR File Check Request is not made in person by the current or prospective operator)
appeared before me and executed this instrument
(Requestor’s Name)
this
day of
,
in the city/county of
(Month)
(Year)
Notary Public
My commission expires
Seal or Stamp
(Notary Public)
FOR DEPARTMENT USE ONLY
Date Received
Date Sent
Other
TYPE OF IDENTIFICATION:
( ) Valid Photo Driver License
( ) State – issued Photo ID
( ) Birth Certificate
( ) Valid Passport
( ) Valid Military ID
( ) Military Discharge Papers
( ) Other (specify)
Employee Verifying Applicant Identification (Print Name)
Signature
LI-15 (8/06)
Request for National Driver Register (NDR) Record Checks
Who May Obtain an NDR Record Check
Employers of drivers and locomotive engineers may obtain NDR records checks. Air carriers are required to obtain NDR
record checks on pilot applicants. Every driver or operator 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 prospec-
tive employer. If no employer is named on the form or it is changed, the request will not be processed.
NDR CHECK AUTHORIZATIONS:
Motor Vehicle Operators - Section 30305(b)(2) of 49 U.S.C. authorizes NDR checks on informa-
tion reported within the past 3 years from the date of inquiry. Driver control actions reported prior to
that time, even if still in effect, will not be included.
Locomotive Railway Operators - Section 30305(b)(4) of 49 U.S.C. authorizes a NDR check for
license withdrawal actions entered in the NDR during the 36-month period prior to the date of this
request and license withdrawal actions open at the time of file check, regardless of date entered in
the NDR.
Pilots - 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. The search is limited to information about revocations or sus-
pensions still in effect on the date of the request or information entered in the NDR in the past 5
years from the date of the request.
How to Request an NDR Record Check on Current or Prospective Employee
Using this form, which may be completed by either the current or prospective employer or the current or prospective
employee, (1) the driver/operator must authorize the request by his or her signature or mark as witnessed and (2) the driv-
er/operator must certify his or her identity. The mailed NDR record check request must be notarized to certify the
driver’s/operator’s identity.
Requests made in person will only be accepted at the Texas Department of Public Safety Headquarters Office located at
5805 North Lamar Boulevard, Austin, Texas. Certification of identity acceptable to the state through one or more docu-
ments issued by a recognized organization which contain a means of verification such as a photograph or a signature is
required when making the request in person.
A $4.00 processing fee in the form of a personal check, money order or cashiers check made payable to the Texas
Department of Public Safety will be required for each NDR record check request. Mail the completed request form and fee
to:
License Issuance Bureau
Texas Department of Public Safety
PO Box 15999
Austin, Texas 78761-5999
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