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License Event Notification Consent Form

The status and validity of a driver’s license must be verified in order to operate a State owned/leased/rented vehicle. The New York State Department of Motor Vehicles has such a program called LENS (License Event Notification Service). By completing this form below, you will be giving the University permission to seek this verification.

 

I,_____________________________________________________, hereby authorize the University to verify my driver’s license information. This is a Department of Motor Vehicle record check to determine my eligibility to drive a New York State owned, leased or rented vehicle. I also certify that I do not have a physical/medical condition that would impair my ability to operate a vehicle.

 

Email: (Required For Online Training): __________________________________ 

SUNY Binghamton Department and  Supervisor To notify of License Check and Online Training Results:  ___________________________________________________ 

Information from Drivers License:

Driver's License ID#:_______________

Driver’s License State:______________

Name: Last, Middle, First ____________,____________,____________

Date of Birth:_____/_____/______

Check where appropriate: Female:__ Male:__

 

Signature:_____________________________________ Date:________________

 Upon completion, please seal in an envelope and forward to Ken Waskie, Director of Purchasing, McGuire Building.

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Last Updated: 10/4/12