|
W.K.U. POLICE
DEPARTMENT REQUEST FOR DRIVING
RECORD TRANSCRIPT Name
___________________________________________________________________ Address__________________________________________________________________ City__________________________________ State ____________ Zip _________ Date
of Birth _______________________________________ Sex _________________ Social
Security Number _______________________ Driver’s
PURPOSE OF THIS REQUEST:
Employment I authorize you to furnish a copy of my driving record
to the Western Kentucky University Police Department. A photocopy of this form will be valid as an
original even though the photocopy does not contain an original writing
of my signature.
SIGNATURE _________________________________________ DATE ___________ (Revised: 6/13/02) |