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Employer Pull Notice EPN Program Form Information

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Employer Pull Notice EPN Program Form Information

Forms


Commercial Employer Pull Notice Requester Account Notice of Change (INF 4)

The INF 4 form:

  • is used when any changes occur to the company name, address, phone number, or contact person of an employer enrolled in EPN
  • must be submitted by the employer within 10 days of occurrence to avoid delays in receiving the Driver Record Printouts (DL 414), or possible closure due to the DMV receiving returned unclaimed mail.
  • must contain the employer's EPN requester code.

Note: Any changes of ownership, including most mergers, require closing the existing EPN Account and establishing a new account with the new owner/employer information.

The department cannot accept forms submitted by e-mail at this time.

Please mail the completed form to the following address:

Department of Motor Vehicles
EPN Program - H265
P. O. Box 944231
Sacramento, California 94244-2310

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Commercial Employer Pull Notice Enrollment or Deletion of Drivers (INF 1100)

The INF 1100 form:

  • is used when an employer adds California licensed drivers or deletes any driver currently enrolled in the EPN Program.
  • must contain the employer's EPN requester code number.
  • provides a "Remarks" column for employers to add information to the "Driver Record Report" (DL 414), for example: terminal site, vehicle plate/VIN number, or employee identification number.
  • upon enrollment of a driver, will generate a "Driver Record Report".
  • $5 enrollment fee due for each driver enrolled on a commercial account.

The department cannot accept forms submitted by e-mail at this time.

Please mail the completed form to the following address:

Department of Motor Vehicles
EPN Program - H265
P. O. Box 944231
Sacramento, California 94244-2310

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Authorization for Release of Driver Record Information (INF 1101)

The INF 1101 form:

  • is used when an employer enrolls a non-mandated driver in the EPN Program.
  • must be completed by the non-mandated driver and the employer.
  • must be completed and retained at the employer's principal place of business.
  • must be available upon request to DMV staff.

Do not return this form to DMV.

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Commercial or Government Employer Pull Notice Enrollment of Out-of-State Licensed Drivers (INF 1102)

The INF 1102 form:

  • is used when a commercial or government employer adds an out-of-state licensed driver to the EPN program.
  • is not used to delete drivers.
  • must contain the employer's EPN requester code.
  • upon enrollment of a driver, will generate a "Driver Record Report" containing the assigned X number and information from the California DMV database, which may include prior record information.
  • requires that all fields for each driver be completed for processing.
  • $5 enrollment fee due for each driver enrolled on a commercial account.
  • requires a copy of the drivers out-of-state license be submitted.

The department cannot accept forms submitted by e-mail at this time.

Please mail the completed form to the following address:

Department of Motor Vehicles
EPN Program - H265
P. O. Box 944231
Sacramento, California 94244-2310

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Government Employer Pull Notice (INF 1103)

The INF 1103 form:

  • is used when a government employer adds California licensed drivers or deletes any driver currently enrolled in the EPN Program.
  • must contain the government employer's EPN requester code number.
  • provides a "Remarks" column for employers to add information to the "Driver Record Report", for example: terminal site, vehicle plate/VIN number, or employee identification number.
  • upon enrollment of a driver, will generate a "Driver Record Report".
The department cannot accept forms submitted by e-mail at this time.

Please mail the completed form to the following address:

Department of Motor Vehicles
EPN Program - H265
P. O. Box 944231
Sacramento, California 94244-2310

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Application for Employer Pull Notice Account (INF 1104)

The INF 1104 form:

  • is used when a commercial employer enrolls in the EPN Program.
  • requires that all fields be completed.
  • A minimum of one driver must be enrolled with the application.
  • $5 enrollment fee due for each driver enrolled on a commercial account.
The department cannot accept forms submitted by e-mail at this time.

Please mail the completed form to the following address:

Department of Motor Vehicles
EPN Program - H265
P. O. Box 944231
Sacramento, California 94244-2310

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Employer Pull Notice Program Requirements (INF 1107)

The INF 1107 form:

  • lists all EPN program requirements.
  • requires employers to agree to all terms and requirements contained on the INF1107 by signing the Application for Employer Pull Notice Account (INF 1104).

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Request for Closure of Employer Pull Notice Account (INF 1112)

The INF 1112 form:

  • is used to close current EPN accounts.
  • requires that all fields be completed.
  • must contain the employer's EPN requester code number.
The department cannot accept forms submitted by e-mail at this time.

Please mail the completed form to the following address:

Department of Motor Vehicles
EPN Program - H265
P. O. Box 944231
Sacramento, California 94244-2310

Back to Top of Page

Employer Pull Notice

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