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I understand that enrollment in the EPN program is in an effort to promote driver safety, and that my driver license report will be released to my employer to determine my eligibility as a licensed driver for my employment.  \nEXECUTED AT: CITY COUNTY STATE  \n\n| DATE | SIGNATURE OF EMPLOYEE\u003Cbr>X |\n| --- | --- |\n| I,   , of  \u003Cbr>AUTHORIZED REPRESENTATIVE COMPANY NAME\u003Cbr>do hereby certify under penalty of perjury under the laws in the State of California, that I am an authorized representative of this company, that the information entered on this document is true and correct, to the best of my knowledge and that Iam requesting driver record information on the above individual to verify the information as provided by said individual. This record is to be used by this employer in the normal course of business and as a legitimate business need to verify information relating to a driving position not mandated pursuant to CVC Section 1808.1. The information received will not be used for any unlawful purpose. I understand that if I have provided false information, I may be subject to prosecution for perjury (Penal Code Section 118) and false representation (CVC Section 1808.45) . These are punishable by a fine not exceeding five thousand dollars ($5,000) or by imprisonment in the county jail not exceeding one year, or both fine and imprisonment. I understand and acknowledge that any failure to maintain confidentiality is both civilly and criminally punishable pursuant to CVC Sections 1808.45 and 1808.46. |  |\n| EXECUTED AT: CITY COUNTY STATE |  |\n| DATE | SIGNATURE AND TITLE OF AUTHORIZED REPRESENTATIVE\u003Cbr>X |\n\nTo obtain a driver record on a prospective employee you may submit an INF 1119 form. To add this driver to the EPN Program you must submit the applicable forms: INF 1100, INF 1102, INF 1103, INF 1103A form. You may obtain forms at our website [at www.dmv.ca.gov/otherservices](at www.dmv.ca.gov/otherservices), or by calling 916-657-6346 .  \nTHIS FORM MUST bE COMPLETED AND retained at the employer’s principal place of business and  \nMADE AVAILAbLE UPON REqUEST TO DMV STAFF.  \nDO not RETURN THIS FORM TO DMV.  \nINF 1101 ENGLISH (REV. 9/2004)  \nClear Form  \nPrint","cbCaijGZ7VTYksVd","https://ap.wps.com/l/cbCaijGZ7VTYksVd","pdf",216879,"English","# Authorization for Release of Driver Record Information\n## Employee authorization (EPN program)\n## Authorized representative certification\n## Form use and submission instructions","[{\"question\":\"What does the employee authorize the California DMV to do?\",\"answer\":\"The employee authorizes the California Department of Motor Vehicles (DMV) to disclose or make available the employee’s driving record information to the employer.\"},{\"question\":\"When may the employer receive the driver record report under the EPN program?\",\"answer\":\"The employer may receive a driver record report at least once every twelve (12) months, or when a subsequent conviction, failure to appear, accident, or suspension or revocation affects the employee’s driving privilege during employment.\"},{\"question\":\"Who must certify the company information and what are the consequences for false information?\",\"answer\":\"An authorized representative must certify the entered information and the business need to verify the individual. The form states that providing false information may lead to prosecution for perjury and false representation, and confidentiality failures may lead to civil and criminal penalties.\"}]","California DMV Employer Pull Notice (EPN) Authorization for Release of Driver Record Information - INF 1101 | PDF",1789873974]