<%@ Page Title="" Language="vb" AutoEventWireup="false" MasterPageFile="~/Driver2/Application/Application2.master" CodeBehind="AgreementDrivingRecord.aspx.vb" Inherits="Web.AgreementDrivingRecord" %>
<%@ MasterType VirtualPath="Application2.Master" %>
<%@ Register Src="~/_include/controls/Signature.ascx" TagPrefix="ctrl" TagName="Signature" %>
<%@ Register Src="~/_include/controls/StatePicker.ascx" TagPrefix="ctrl" TagName="StatePicker" %>
<%@ Register Src="~/_include/controls/YesNoPicker.ascx" TagPrefix="ctrl" TagName="YesNoPicker" %>

<asp:Content ID="Content1" ContentPlaceHolderID="phContent" runat="server">

    <h1>Request for Check of Driving Record</h1>

    <section id="release">
        <p>I hereby authorize you to release the following information to <span class="autofilled"><%= Master.app.clientName %></span> and their agents for the
purposes of investigation as required by §391.23 and §391.25 of the Federal Motor Carrier Safety Regulations. If
hired, I authorize an annual check of my motor vehicle record as required by §391.25 of the Federal Motor Carrier
Safety Regulations. You are hereby released from any and all liability which may result from furnishing such
information.</p>
        <ul class="formFields">
            <li>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="ynAgree"
                    Text="required" Display="Dynamic" CssClass="required" />
                <asp:Label runat="server" AssociatedControlID="ynAgree"
                    Text="Agree" />
                <ctrl:YesNoPicker ID="ynAgree" runat="server" />
            </li>
        </ul>
    </section>

    <section class="preview">
        <h1>Motor Carrier</h1>

        <p>In accordance with the provisions of Sections 604 and 607 of the <em>Fair Credit Reporting Act</em>, Public Law 51-908, as amended by the
Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter 1, of Public Law 104-208), I hereby certify the following:</p>

        <ol>
            <li>The consumer (applicant) has authorized in writing the procurement of this report.</li>
            <li>The consumer (applicant) has been informed in a separate written disclosure that a consumer report may be obtained for
employment purposes.</li>
            <li>The information requested below will be used for a “permissible purpose” (i.e., information for employment purposes) and
will be used for no other purpose;</li>
            <li>The information being obtained will not be used in violation of federal or state equal opportunity law or regulation; and</li>
            <li>Before taking an adverse action based in whole or in part on the report the consumer (applicant) will receive a copy of the
requested report and the summary of consumer rights as provided with the report by the consumer reporting agency.</li>
        </ol>

        <p>I also hereby certify that this report request and the above applicant’s release notice meet the definition of “permissible uses” of
state motor vehicle records under the provisions of the <em>Driver’s Privacy Protection Act of 1994</em> (Public Law 103-322, Title XXX,
Section 300002(a)).</p>

        <ul class="formFields">
            <li class="left big">
                <label>Requester's Signature</label>
                <input disabled="disabled" />
            </li>
            <li class="right">
                <label>Date</label>
                <input disabled="disabled" />
            </li>
            <li class="big">
                <label>Printed Name</label>
                <input disabled="disabled" />
            </li>
            <li class="big">
                <label>Requester's Company</label>
                <input disabled="disabled" />
            </li>
        </ul>

        <ul class="formFields">
            <li class="big">
                <label>Street</label>
                <input disabled="disabled" />
            </li>
            <li class="left">
                <label>City</label>
                <input disabled="disabled" />
            </li>
            <li class="left">
                <label>State</label>
                <select disabled="disabled"></select>
            </li>
            <li class="right">
                <label>Zip</label>
                <input disabled="disabled" />
            </li>
        </ul>

        <ul class="formFields">
            <li>
                <input type="checkbox" disabled="disabled" />
                <label>The following named person has made application with our company for the position of </label>
                <input disabled="disabled" />
                <p>In accordance with §391.23 of the U.S. Department of Transportation Regulations, please furnish the above signed with the
applicant’s driving record for the past three (3) years.</p>
            </li>
            <li>
                <input type="checkbox" disabled="disabled" />
                <label>The following named person is employed with our company in the position of </label>
                <input disabled="disabled" />
                <p>In accordance with §391.25 of the U.S. Department of Transportation Regulations, please furnish the above signed with the
employee’s driving record for the past year.</p>
            </li>
        </ul>

        <ul class="formFields">
            <li class="big">
                <asp:Label runat="server" AssociatedControlID="txtApplicantName"
                    Text="Name of Applicant/Employee" />
                <asp:TextBox ID="txtApplicantName" runat="server"
                    Enabled="false" />
            </li>
        </ul>

        <ul class="formFields">
            <li class="big">
                <asp:Label runat="server" AssociatedControlID="txtApplicantStreet"
                    Text="Address" />
                <asp:TextBox ID="txtApplicantStreet" runat="server"
                    Enabled="false" />
            </li>
            <li class="left">
                <asp:Label runat="server" AssociatedControlID="txtApplicantCity"
                    Text="City" />
                <asp:TextBox ID="txtApplicantCity" runat="server"
                    Enabled="false" />
            </li>
            <li class="left">
                <asp:Label runat="server" AssociatedControlID="ddlApplicantState"
                    Text="State" />
                <ctrl:StatePicker ID="ddlApplicantState" runat="server"
                    Enabled="false" />
            </li>
            <li class="right">
                <asp:Label runat="server" AssociatedControlID="txtApplicantZip"
                    Text="Zip" />
                <asp:TextBox ID="txtApplicantZip" runat="server"
                    Enabled="false" />
            </li>
        </ul>

        <ul class="formFields">
            <li class="big">
                <asp:Label runat="server" AssociatedControlID="txtApplicantStreetOld"
                    Text="Former Address" />
                <asp:TextBox ID="txtApplicantStreetOld" runat="server"
                    Enabled="false" />
            </li>
            <li class="left">
                <asp:Label runat="server" AssociatedControlID="txtApplicantCityOld"
                    Text="City" />
                <asp:TextBox ID="txtApplicantCityOld" runat="server"
                    Enabled="false" />
            </li>
            <li class="left">
                <asp:Label runat="server" AssociatedControlID="ddlApplicantStateOld"
                    Text="State" />
                <ctrl:StatePicker ID="ddlApplicantStateOld" runat="server"
                    Enabled="false" />
            </li>
            <li class="right">
                <asp:Label runat="server" AssociatedControlID="txtApplicantZipOld"
                    Text="Zip" />
                <asp:TextBox ID="txtApplicantZipOld" runat="server"
                    Enabled="false" />
            </li>
        </ul>

        <ul class="formFields">
            <li class="left">
                <asp:Label runat="server" AssociatedControlID="txtDateBirth"
                    Text="Date of Birth" />
                <asp:TextBox ID="txtDateBirth" runat="server"
                    Enabled="false" />
            </li>
            <li class="right">
                <asp:Label runat="server" AssociatedControlID="txtSocial"
                    Text="Social Security No" />
                <asp:TextBox ID="txtSocial" runat="server"
                    Enabled="false" />
            </li>
            <li class="left">
                <asp:Label runat="server" AssociatedControlID="txtLicenseNumber"
                    Text="Driver's License No." />
                <asp:TextBox ID="txtLicenseNumber" runat="server"
                    Enabled="false" />
            </li>
            <li class="right">
                <asp:Label runat="server" AssociatedControlID="ddlLicenseState"
                    Text="Driver's License State" />
                <ctrl:StatePicker ID="ddlLicenseState" runat="server"
                    Enabled="false" />
            </li>
        </ul>

    </section>

</asp:Content>
