Equipment Maintenance Division - Services - Motor Vehicle Record Request Authorization

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I AUTHORIZE the City of New Orleans and its designated agent(s) to obtain copies of my Official Driving Record (ODR) or, generally, my driving record, including moving violations, driving while under the influence and driver’s licensure status.
I DECLINE this authorization and forfeit my eligibility to operate city vehicles and heavy equipment and to seek mileage reimbursement.

Name as it appears on driver’s license*

Driver’s license number*

State*

Are you an employee of City of New Orleans?

YesNo

I certify that all of the information provided on this form is accurate. This authorization/declination is valid until revoked by me in writing*

Type name to sign

Enter your nola.gov email address. If you do not have one have one, please enter your personal email or the email of HR Manager or Vehicle Coordinator*

The form will be sent to this email address. It is your responsibility to print the form and submit it to your Department’s Vehicle Coordinator.

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