PennDOT DL-9105 Employment Affidavit of Intended Use

PennDOT DL-9105 Employment Affidavit of Intended Use – Businesses in Pennsylvania that need to request driver records for hiring or employment verification must comply with strict privacy and data use rules. The official document that enables this is the Pennsylvania PennDOT Form DL-9105 – Employment Affidavit of Intended Use. This form is issued by the Pennsylvania Department of Transportation (PennDOT) and is required for authorized access to driver history information through the Information Sales Unit or approved providers.

This comprehensive guide explains what Form DL-9105 is, who needs it, how to complete it correctly, submission requirements, and key compliance obligations under Pennsylvania and federal law. The information is current as of 2026 and draws from official PennDOT resources.

What Is PennDOT Form DL-9105?

Form DL-9105 is the Employment Affidavit of Intended Use used by individuals, partnerships, corporations, and non-profit organizations seeking access to Pennsylvania driver records strictly for employment purposes. It serves as a formal sworn statement that the requester will use the information only for legitimate hiring, continued employment screening, or related job-related verification.

The current version is marked DL-9105 (5-22). It is part of PennDOT’s system for releasing driver information under the Pennsylvania Vehicle Code and in compliance with the federal Driver’s Privacy Protection Act (DPPA). Without a properly completed and notarized DL-9105, businesses generally cannot obtain bulk or account-based access to driver records for employment screening.

Official download link (always use the most recent version from the state site):

Download Official PennDOT Form DL-9105 PDF

Who Needs to File Form DL-9105?

Any business or organization that wants to establish or maintain an account to request Pennsylvania driver records for employment reasons must submit this affidavit. Typical users include:

Employers screening job applicants or current employees who drive as part of their duties
Companies that hire commercial drivers, delivery drivers, or fleet operators
Non-profit organizations and partnerships performing employment-related background checks involving driving records
Businesses working through approved information providers that require the affidavit for sub-accounts

Note that pure employment screeners (third-party background check companies) may have additional restrictions and should contact PennDOT directly. The form is not for personal use, insurance underwriting (separate processes exist), or any non-employment purpose.

Key Sections of the Form

The DL-9105 form collects essential business identification and ownership details, then requires the authorized signer to initial nine specific declarations. Major sections include:

Business Type – Check one: Individual, Partnership, Corporation, or Non-Profit
Legal Business Name and any D/B/A name
Person Responsible – Name and title of the authorized individual
Physical Address, city, state, ZIP, telephone, fax, email, and website
Federal Employer Identification Number (EIN), year established, incorporation details (if applicable), Dun & Bradstreet number, and U.S. DOT number (if applicable)
Location of Records – Address where records are kept for potential PennDOT audit
Type of Business description
Ownership – List of individuals, partners, or corporate officers who control or manage the business (name, title, phone, email)
Account/Subaccount Information – Whether it is an update and any existing numbers

The reverse side contains detailed instructions emphasizing complete answers (use “N/A” where information does not apply) to avoid processing delays.

The Nine Required Declarations

The heart of the form is the set of nine sworn statements that the authorized person must initial. These affirmations protect driver privacy and limit use of the data:

Requested information will be used for employment purposes only.
A signed release is on file for every driver whose record is requested.
The requester understands the records are confidential and will establish procedures to protect that confidentiality.
Driver information will never be requested for personal reasons (examples include checking relatives or locating someone’s address for non-job reasons).
Information obtained will not be sold, assigned, or transferred to any other party.
PennDOT retains exclusive ownership of the data; records will not be combined or linked into other databases.
Information will not be used for direct mail advertising or any other mailings.
Personal information will not be disseminated or published on the Internet without express written permission from the Department.
All statements are true and subject to penalties under 18 Pa. C.S. § 4903(a)(2) for false swearing (fine up to $5,000, imprisonment up to two years, or both).

These declarations align with both state law and the federal Driver’s Privacy Protection Act.

How to Complete and Submit Form DL-9105?

Follow these steps carefully:

Download the current official PDF from the PennDOT website (link provided above).
Have an authorized member of the firm (listed in the Ownership section) complete every applicable field. Use blue or black ink if printing; type preferred when possible.
Initial each of the nine declaration statements.
Sign and date the form in the presence of a notary public. The notary must complete the acknowledgment section.
Mail the completed, notarized original to the address specified by your information provider (often an approved vendor such as those working with PennDOT’s Information Sales Unit). Do not email or fax the notarized form unless specifically instructed.
If any business information changes (name, address, ownership, phone, website, etc.), a new notarized DL-9105 must be filed promptly.

Incomplete forms are returned, causing delays. Always keep a copy for your records.

Related Requirements and Online Access

Once the affidavit is approved, businesses may gain access to PennDOT’s online driver history request service. Separate Internet Application/Licensing Agreements (such as forms for general employers, commercial driver employers, or school bus contractors) are typically required along with applicable fees. Driver record fees are set by statute (commonly around $14–$15 per record as of recent updates) and are paid per request or under unlimited-access arrangements for certain commercial employers.

For commercial motor vehicle (CMV) drivers, additional federal requirements under FMCSA rules apply, including driver qualification files and consent forms. The DL-9105 specifically addresses the Pennsylvania state record request process.

Official resources for further information:

Penalties for Misuse or False Statements

Misuse of driver record information or false statements on the affidavit can result in serious consequences, including criminal penalties under Pennsylvania law for false swearing, civil liability, revocation of access privileges, and potential federal DPPA violations. Always limit use strictly to employment purposes and maintain signed employee/applicant releases.

Frequently Asked Questions

Is the form available as a fillable PDF?
The official version is a downloadable PDF. Many users print and complete it by hand or use PDF software to fill fields before printing for notarization.

How often must the form be renewed?
A new form is required whenever business information changes. Some account types also require annual renewals of related licensing agreements.

Can individuals use DL-9105 for personal driving records?
No. Individuals request their own records using Form DL-503 or online services. DL-9105 is exclusively for employment-related business use.

Where can I get help completing the form?
Contact your approved information provider or PennDOT’s Information Sales Unit / Driver and Vehicle Services for guidance. Do not rely on unofficial third-party templates that may be outdated.

Conclusion

The Pennsylvania PennDOT Form DL-9105 – Employment Affidavit of Intended Use is an essential compliance document for any U.S. business that needs legitimate access to Pennsylvania driver records for hiring and employment decisions. Proper completion, notarization, and adherence to the nine declarations protect both the business and the privacy of drivers while meeting state and federal requirements.