For validation only
106-060-421-0005
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Driving Record Request
Each driving record requested is $15 and is non-refundable.
Purchase online (for fastest service):
• Your own driving record – login to License eXpress at dol.wa.gov/
licenseexpress.html. You can print or save it and it’s available for 30
days if you need to print it again.
• Driving records for authorized business needs – login and create a business account in License eXpress
at dol.wa.gov/licenseexpress.html. You can print or save your records and they are available for 30 days if you
need to print them again.
Purchase by mail (allow 10 business days for processing):
• Use this form. We will send the record to you or the individual or company you indicate below. Mail this
completed form and a non-refundable $15 fee for each record in a check or money order, payable to
Department of Licensing, to:
Driver Records, Department of Licensing, PO Box 3907, Seattle, W
A 98124-3907
NOTE: If you are requesting a driving record for an employee, prospective employee, or volunteer, you
must get a Driving Record Release of Interest (available at dol.wa.gov/driverslicense) from the driver before
making your request. Do not mail it to us, keep it in your les.
If you have additional questions, contact customer service at 360.902.3900.
Requestor information
PRINT or TYPE Requestor name 10-digit daytime phone number
Business name (if applicable)
Mailing or Business address (Street address or PO Box) City State ZIP code
How do you want the driving records sent? (Choose one)
Email Fax U.S. mail (1 record only)*
Email 10-digit fax number
*We will not mail more than one driving record. Multiple record requests are sent only by email or fax.
Driving record requested
PRINT or TYPE Name (Last, First, Middle initial)
Date of birth Washington driver license number
Type of record requested
Insurance records show violations, convictions, and accidents only. Other drive records show trac-related
collisions, convictions, violations, suspensions, revocations, and disqualications.
We oer the following types of driving records:
Alcohol/Drug assessment – Used by chemical dependency agencies.
Employment record – Used by employers, volunteer organizations, and transit authorities to determine
eligibility. Also used by state and federal agencies to carry out their functions.
Insurance record (3 years) – Used to create and renew life, vehicle, and commercial vehicle insurance policies.
Full record – Used by legal representation or self-requested by the person named on the record.
NOTE: If more than one record type is selected, include $15 for each additional record.
I certify under penalty of perjury that I am entitled by federal or state laws to obtain an abstract of the driving
record of the individual requested.
Date and place (city or county) signed Signature
If requesting additional driving records, attach separate sheets for each driving record requested.
Include a $15 non-refundable fee for each record.
RCW 46.52.130, 18 USC Chapter 123
DR-500-009 (R/7/23)VWA
When completed, print this form and sign here.
Driver Record Request Form Data Sharing Agreement – General Form
This Data Sharing Agreement (Agreement) is between the Washington State Department of Licensing (DOL), and the entity (Requestor)
named on the Driver Record Request form (Form). By submitting this Form to DOL, Requestor acknowledges and agrees to the following:
1. DEFINITIONS: The following terms have the meanings set forth below:
• “Drive Record” is a copy of a driving record that includes a history of violations, convictions, collisions, and departmental actions
incurred by a driver over a period of time. It may not include the license original issue date.
• “Condential Information” means information that may be exempt from disclosure to the public or other unauthorized persons under
state or federal statutes. Condential Information includes, but is not limited to information that identies an individual, including an
individual’s photograph, social security number, name, address (but not the ve-digit zip code), telephone number, medical or disability
information, credit card information, driver license numbers, law enforcement records, and banking proles.
• “Permissible Use” means only those users authorized in this Agreement.
2. GRANT OF LICENSE: Subject to the terms and conditions of this Agreement, DOL agrees to grant Requestor with a limited non-
transferable license to have access to selected Driver Records. At all times DOL remains the owner of all data contained in Driver Records
provided under this Agreement.
3. COMPENSATION: Requestor will pay a non-refundable fteen dollars ($15.00) for each Driver Record, which Requestor will include when
submitting the Form. If the established amount changes, Requestor will pay the updated amount as set by statute. In the event Requestor
does not make timely full payment, the unpaid debt may be subject to applicable interest and fees and eventual collection practices as
allowed by law. DOL may refuse to provide future Driver Records until Requestor is current with all payments.
4. ACCESS REVIEW ON DRIVER RECORDS: Requestor must actively monitor to ensure that all Driver Records are accessed or used only
for ocial job responsibilities. Requestor must immediately bar the access to anyone who accesses or uses Driver Records outside of a
Permissible Use specically allowed for in this agreement.
5. RELEASE OF INTEREST – EMPLOYERS AND VOLUNTARY ORGANIZATIONS: If Requestor is requesting Driver Record(s) as an
employee prospective employee, or volunteer, Requestor must rst obtain a Release of Interest signed by: a) The employee, prospective
employee, or prospective volunteer that authorizes the release of the Driver Record; and b) The employer or volunteer organization
attesting that the information is necessary for employment purposes related to driving by the individual as a condition of employment or
otherwise at the direction of the employer or the volunteer organization. If the employer, prospective employer, or volunteer organization
authorizes an agent to obtain this information on their behalf, the use of the agent must be noted in the Release of Interest.
For employer and prospective employer purposes, the Release of Interest must also note that any information contained in the Driver
Record related to an adjudication that is subject to a court order sealing the juvenile record of an employee or prospective employee may
not be used by the employer or prospective employer, or an agent authorized to obtain this information on their behalf, unless required
by federal regulation or law. The employer or prospective employer must aord the employee or prospective employee an opportunity to
demonstrate that an adjudication contained in the abstract is subject to a court order sealing the juvenile record.
The Release of Interest must be signed by the employee, prospective employee, or volunteer organization before the Requestor requests
the Driver Record.
DOL may audit Requestor at any time to verify that all Release of Interests were executed prior to requesting such records, and that all
necessary information was contained in the Release of Interests.
6. SAFEGUARDING OF CONFIDENTIAL INFORMATION: Driver Records provided pursuant to this Agreement include Condential
Information. Requestor acknowledges and agrees that it has a continuing obligation to comply with all federal and state laws, regulations,
and security standards as enacted or revised over time, regarding, protection of Condential Information, data security, electronic data
interchange and restricted uses of such information.
Requestor must maintain and support administrative, technical or physical methods used to monitor compliance with the Data Safeguards
and Permissible Use(s) authorized in this Agreement across all Requestor business practices.
7. SAFEGUARDING POLICIES AND PROCEDURES: Requestor must maintain written policies and procedures to ensure Condential
Information is safeguarded and only used as authorized herein. At a minimum, the policies and procedures must include: a) limited access
to only necessary personnel, b) view only access to Condential Information, c) proper storage and handling of electronic and hard
copy documents containing Condential Information, and d) training requirements on the Permissible Use(s) to personnel with access to
Condential Information).
8. PERMISSIBLE USE: Driver Records may only be used for lawful actions authorized under RCW 46.52.130 (http://app.leg.wa.gov/
RCW/default.aspx?cite=46.52.130), and as approved by DOL after reviewing Requestor’s Form. Any other use is strictly prohibited. This
prohibition includes, without limitation, the use of a Driver Record for purposes of investigating, locating, or apprehending individuals for
immigration related violations. Any entity receiving an Driver Record under the Permissible Uses listed under RCW 46.52.130 must use
the Driver Record exclusively for its own purposes or as expressly permitted under RCW 46.52.130, and may not divulge any information
contained in the Driver Record to a third party.
A negligent violation of RCW 46.52.130 is a gross misdemeanor. Any intentional violation is a class C felony.
9. DISPOSAL OF CONFIDENTIAL INFORMATION: Requestor shall dispose of any Driver Record at any time when Requestor’s immediate
use of that record is no longer needed.
10. GOVERNANCE: This Agreement is governed by the laws of the state of Washington and any applicable federal laws. Venue for any legal
action arising out of this Agreement is the Thurston County Superior Court. In the event of an inconsistency in terms of this Agreement, or
between the terms and any applicable statute or rule, the inconsistency will be resolved by giving precedence in the following order:
1) Applicable federal and Washington State laws, and regulations; 2) Terms and conditions of this Agreement; and 3) The Requestor’s
Form, which is incorporated herein.
11. INDEPENDENT CAPACITY: The scope of this Agreement maintains each Party’s independent status as a self-governed entity, and
nothing herein may be deemed as allowing any employee or agent of one Party to be considered as the employee or agent of the other
Party.
12. INTEGRITY OF DATA: DOL compiles its data based in part on the reporting of information from outside individuals and entities; DOL may
not be held liable for any errors which occur in compilation of data.
13. HOLD HARMLESS: Requestor shall hold DOL harmless for any damages or claims arising from its own acts and/or omissions, which
includes those acts or omissions of its employees and agents. For any matters concerning Data Security, safeguarding, and Permissible
Use, Requestor will be held to a strict liability standard.
14. RECORDS ACCESS AND INSPECTIONS: Requestor, at the request of DOL, must provide, access to all records retained in connection
with the receipt of Driver Records under this Agreement. Upon request, such records must be made available for audit, inspection, review,
and/or copying at no additional cost to DOL. DOL has the right to audit Requestor at any time, at Requestor’s expense, to verify that
Requestor is complying with all data security and permissible use requirements herein.
15. SEVERABILITY: If any provision of this Agreement or any provision of any document incorporated by reference shall be held invalid, such
invalidity shall not aect the other provisions of this Agreement which can be given eect without the invalid provision, if such remainder
conforms to the requirements of applicable law and the fundamental purpose of this Agreement, and to this end the provisions of this
Agreement are declared to be severable.
16. WAIVER: The omission of either Party to exercise its rights under this Agreement does not preclude that Party from subsequent exercising
of such rights and does not constitute a waiver of any rights under this Agreement, unless stated as such in writing, and signed by an
authorized representative of the Party.
