Disclosure and Authorization Form
Georgetown University, Risk Management

I understand that Risk Management will obtain a Motor Vehicle Report from the university’s third-party vendor to determine my authorization to drive a vehicle that is owned, leased or rented by the university. A copy of the Georgetown University Vehicle Policy is available on Risk Management’s website. I agree to abide by this policy, and by all applicable laws and regulations pertaining to the operation of motor vehicles. I understand that I must report any incident to the university that would render me ineligible to drive a university vehicle.

Embark Safety LLC

In connection with vehicle operation for Georgetown University, I authorize Georgetown University to request a Motor Vehicle Report for me for vehicle operation purposes from Embark Safety LLC. Such reports will consist of information issued from the state department of motor vehicles and will reveal my motor vehicle/driving records.
I authorize the Department of Motor Vehicles that may have information relevant to my driving record to disclose the same to Georgetown University. Embark Safety LLC does not sell or otherwise provide any of the information found in its reports to any party other than the university.
I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any Motor Vehicle Report of which I am the subject upon my written request. I also understand that I may receive a copy of my Motor Vehicle Report and written summary of my rights under the provisions of the Fair Credit Reporting Act (“FCRA”), 15 U.S.C. § 1681 et. seq. I agree that this authorization shall remain valid for the duration of my employment or affiliation with Georgetown University. I certify that the information contained on this Authorization form is true.