Form 419M PDF Alaska - DRIVING RECORD COMPANY REQUEST (MULTIPLE RECORDS)

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Form 419M Rev. 3/2021 www.a laska.gov/dmv STATE OF ALASKA DIVISION OF MOTOR VEHICLES COMPANY RELEASE FOR MULTIPLE DRIVING RECORDS Company or Business Name (Please Print) Telephone Number The undersigned authorize s the DMV to release their driving record to the above business or company: ALASKA DRIVER LICENSE NUMBER PRINTED NAME CIRCLE RECORD TYPE ** SIGNATURE DATE (Valid for 90 days) Full Individual Insurance CDL Employment Full Individual Insurance CDL Employment Full Individual Insurance CDL Employment Full Individual Insurance CDL Employment Full Individual Insurance CDL Employment Full Individual Insurance CDL Employment Full Indi vidual Insurance CDL Employment Full Individual Insurance CDL Empl oyment Full Indi vidual Insurance CDL Employment Full Individual Insurance CDL Employment ** Driving Record Types ( What’s the difference? ) Full Individual Record : Shows current drivi ng record status, and includes all convictions, license actions, and at -fault accidents on record; includes full medical cer tification details for commercial (CDL) drivers. Insurance Record : Shows current driving record status, and 3 or 5 year history of convictions, license actions, and at - fault accidents required for vehicle insurance purposes; excludes any medical certification information on record. (3 or 5 year reportin g requirement is based on the type of conviction or action.) CDL Employment Record : Shows current drivi ng record status; full medical certification information; and conviction, license action, and at -fault accident information as required by DOT regulations for commercial (CDL) drivers. CDL drivers must select this type of record when used for CDL employment purposes. I want the driving records to be sent via : Email Mail (Select only one) Mailing Address City / State / Zip Email DMV USE ONLY I have verified ID for in - person request Expiration Date: BATCH LOGIN ID / OFFICE TOTAL FEE S: _______ CA CC CK Submit request to DMV Research : 3901 Old Seward Highway, Ste 101 Anchorage, AK 99503 Phone: 907- 269- 5551 Email: [email protected] Fax: (907) 269- 5202

Form 419M - Driving Company Request
Form Name	Form 419M - Driving Company Request
Purpose	To request driving records or information for employment or insurance purposes
Issuing Authority	Alaska Department of Motor Vehicles (DMV) or relevant agency
Eligibility	Typically, companies or employers requesting driving records for prospective or current employees
Application Methods	- Submission method may vary, but often involves in-person or mail submission<br>- Availability may depend on the DMV or agency's procedures
Required Information	- Company or employer information, including name and contact details<br>- Driver information, including name, driver's license number, and consent or authorization<br>- Purpose for requesting driving records
Fees	Fees, if any, may apply for each driving record requested
Purpose for Request	Specify the reason for requesting the driving records, which could include employment screening, insurance coverage, or safety compliance
Driver's Information	Include details about the driver for whom the record is being requested, including full name, date of birth, and driver's license number
Consent or Authorization	Include documentation demonstrating the driver's consent or authorization for the release of their driving records
Submission Instructions	Provide clear guidance on how and where to submit the completed form, including any required attachments
Processing Time	The time it takes to process the request may vary based on the DMV or agency's workload
Delivery Method	Specify how the requested records will be delivered to the company or employer, which may include mail or electronic delivery
Payment Information	Include details on how to pay any required fees and acceptable payment methods
Legal Compliance	Ensure that the request complies with relevant privacy and data protection laws, including obtaining necessary consents
Contact Information	Include contact details for inquiries or additional information
Official Website	Reference the official website of the Alaska DMV or relevant agency for specific instructions and forms

Form 419M PDF