ITD 3261 (Rev. 11/23)

Request for National Driver Register (NDR) File Check on Current or Prospective Employee
Current or Prospective Employer to Receive the NDR Search Results:

Driver Employer

Railroad

Air Carrier

EngineerEmployer or Agency Name

To the Specific Attention of:Business Telephone
Area Code Number()

Mailing Address (Number and Street)

City, State and Zip CodeType or Print Plainly (Avoid delays. Inquiries that cannot be read will not be processed.)
Driver's Full Legal Name (Last, First, Middle)

Driver's License Number and State

Month, Day, and Year of BirthSocial Security NumberSex

Color of Eyes

HeightWeight

Other Names Used (Maiden Name, Prior Name, Nickname, Professional Name, Other)

Mailing Address (Number and Street with Apartment Number if any, or Rural Route/Carrier and Box Number)

City, State and Zip CodeEMPLOYEE UNDERSTANDING: I understand that the National Driver Register (NDR) search will result in a printed report, which will be sent only tothe employer or regulatory agency listed above on this form. The report will indicate either (1) that the NDR does not contain a record matching myidentification or (2) that the NDR has a probable identification (match) from one state (or more) which will be named on the report. A separate check ofstate files would be required (1) to verify the identification or (2) to obtain the driving record. It is the responsibility of the listed employer to obtain thestate driver records and to determine or verify records which apply to me. Under the Privacy Act, I have the right to request record(s) pertaining to me
from the NDR. I also understand that if convictions, suspensions, or revocations of my record are found, which I have not shown on my applications ormentioned during interviews, I might not be hired as a driver or could lose my job as a driver, and the state where I am licensed may also take action
on my driver's license, including suspension, cancellation, or revocation. I hereby, with my signature, authorize a one-time file search of the NDR andany resulting reports to be sent to the employer or agency named on this form.
Driver's Signature (Please read entire document before signing.)

DateNOTARIZATION
Required for processing.
Sworn to and ascribed before me Notary Public
this _______ day of ___________
20_________ in the city/county of____________________________
State of _____________________

Seal or StampRequests for National Driver Register (NDR) Record Checks
Who may obtain an NDR Record Check1) Any person may ask to know whether there is an NDR record on them and may obtain a copy of the record if
one exists. Individual requests must be mailed directly to the National Driver Register. Do not mail Individual
Request Forms to the Department of Motor Vehicles.
2) Employers of drivers, locomotive engineers, and air carriers may also obtain NDR record checks. Every driver,operator or pilot on whom an NDR file check is requested is entitled to review the NDR report(s) provided to theemployer. The results of the NDR check will be mailed only to the current or prospective employer or third party
service provider. If no employer is named on the form, or it is changed, the request will not be processed.

The following authorization applies to Railroad Company Requests
NDR Check Authorization: The U. S. Department of Transportation, Federal Railroad Administration, inaccordance with 49 CFR, Part 240.111, requires that I hereby request and authorize the National Highway TrafficSafety Administration (NHTSA) to perform an NDR check of my driving record for a 36-month period prior to thedate of this request, including license withdrawal actions open at time of file check. I hereby authorize the NDR tofurnish a copy of the results of this NDR check directly to the railroad company identified on this inquiry form.

Notice to prospective Air Carrier Employees
Pursuant to Section 502 of the Pilot Records Improvement Act of 1996, this serves as notice of a request for NDR
information concerning your motor vehicle driving record and your right to receive a copy of such information.

What NDR Records contain:
NDR results for employers will contain only the identification of the state(s) which have reported
information on the driver to the NDR and only information reported within the past 3 years from the date of
the inquiry. Driver control actions initiated prior to that time, even if still in effect, will not be included.
Detailed information to confirm identity or to describe the contents of the driver record can be obtained
only from the state(s) listed when probable matches are reported. The name and address of the driver
licensing official will be provided for each state listed.

How to request an NDR Record Check:
Using this form, which may be completed by either the current or prospective employer or the current orprospective employee, (1) the driver must authorize the request by his or her signature or mark as
witnessed and (2) the driver must certify his or her identity.
Any mailed NDR record check request must be notarized to certify identity. Refer to the acceptable
identification documents listed in the Notary Official Use Only section. The completed form should bemailed to the address listed below:
National Driver Register1200 New Jersey Ave SE
Washington, DC 20590
Requests can only be processed for the employer if the employee holds an Idaho driver's license or if
the employee is domiciled in Idaho and does not hold a driver's license. If the employee holds an out-ofstate license, requests must be processed through the employee's state of license.