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ABCD DRIVER HISTORY REQUEST FORM NEW HIRE The use of an automobile is necessary for the position for which you are applying. If you are considered for employment we will be requesting your automobile driving history over the past three years. The company will not hire people with a driving record that includes 1. Currently suspended driver s license 2. Any employee who has been convicted of a DUI Driving Under the Influence or DWI Driving While Intoxicated in the past three years 3. Any hit and run conviction 4. Any motor vehicle violation or series of violations which in the opinion of management gives rise to a reasonable apprehension that the individual may potentially present a risk to the safety of himself or others or of damage to Company property. TO BE COMPLETED BY DRIVER Name As it appears on License Last First Middle Initial Address City State of Issuance State Zip Driver s License No* Have You Had A Valid License in Any Other State s in the Past Two Years Yes in No Date of Birth The undersigned hereby authorizes the release of my driving record to Boehringer Ingelheim Pharmaceuticals Inc* and/or it s agent s Driver s Signature Revised 10/23/2006 Date DrvrHistNew A1. If you are considered for employment we will be requesting your automobile driving history over the past three years. The company will not hire people with a driving record that includes 1. Currently suspended driver s license 2. The company will not hire people with a driving record that includes 1. Currently suspended driver s license 2. Any employee who has been convicted of a DUI Driving Under the Influence or DWI Driving While Intoxicated in the past three years 3. Any employee who has been convicted of a DUI Driving Under the Influence or DWI Driving While Intoxicated in the past three years 3. Any hit and run conviction 4. Any motor vehicle violation or series of violations which in the opinion of management gives rise to a reasonable apprehension that the individual may potentially present a risk to the safety of himself or others or of damage to Company property. Any hit and run conviction 4. Any motor vehicle violation or series of violations which in the opinion of management gives rise to a reasonable apprehension that the individual may potentially present a risk to the safety of himself or others or of damage to Company property. TO BE COMPLETED BY DRIVER Name As it appears on License Last First Middle Initial Address City State of Issuance State Zip Driver s License No* Have You Had A Valid License in Any Other State s in the Past Two Years Yes in No Date of Birth The undersigned hereby authorizes the release of my driving record to Boehringer Ingelheim Pharmaceuticals Inc* and/or it s agent s Driver s Signature Revised 10/23/2006 Date DrvrHistNew A1. If you are considered for employment we will be requesting your automobile driving history over the past three years. The company will not hire people with a driving record that includes 1. Currently suspended driver s license 2. Any employee who has been convicted of a DUI Driving Under the Influence or DWI Driving While Intoxicated in the past three years 3.

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