Driver Qualification Form – Fill Out and Use This PDF

The Driver Qualification form is a detailed document that is essential for commercial drivers to complete and for companies to maintain on file. It includes a checklist covering various aspects such as employment application, medical examiner's certificate, records of previous employment inquiries, driver's road test certification, and annual reviews of the driver’s record, among others. Filling out this form accurately is crucial for compliance with federal regulations and to ensure safety on the roads. Click the button below to start filling out your Driver Qualification form.

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Driver Qualification Form PDF Details

When commercial driving companies entrust large, potentially dangerous vehicles to drivers, ensuring these individuals possess the necessary qualifications and clean safety records is paramount. To streamline this verification process, the Driver Qualification File Checklist is an industry-standard document utilized extensively across the transportation sector. At its core, this file encapsulates a comprehensive array of essential components ranging from the driver application for employment, detailed inquiries to previous employers spanning three years, checks with state agencies to scrutinize driving records, to the critical aspects of medical certifications and driver's road test certifications. Importantly, the requirement for drivers to carry copies of their Medical Examiner’s Certificate while on the road underscores the checklist's role in not just pre-employment screening but in ongoing compliance and safety verification. Furthermore, the inclusion of a driver's accident and traffic violations history over the past three years, alongside a meticulous record of their employment history for the last decade, enriches the dossier with a nuanced view of a candidate's suitability for driving roles that demand the highest levels of responsibility and care. This robust vetting process ultimately serves a dual purpose: safeguarding public safety on the roads and protecting commercial entities from potential liabilities arising from inadequate driver qualification and monitoring.

Question	Answer
Form Name	Driver Qualification Form
Form Length	12 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	3 min
Other names	driver qualification form, driver qualification file forms, driver list template, dot driver qualification file checklist

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DRIVER QUALIFICATION FILE

CHECKLIST

1.	DRIVER APPLICATION FOR EMPLOYMENT	391.21
2.	INQUIRY TO PREVIOUS EMPLOYERS (3 YEARS)	391.23(a)(2) & (c)
3.	INQUIRY TO STATE AGENCIES	391.23(a)(1) & (b)
4.	MEDICAL EXAMINER’S CERTIFICATE*	391.43
	(MEDICAL WAIVER, IF ISSUED)
5.	DRIVER’S ROAD TEST	391.31
6.	CERTIFICATION OF ROAD TEST*	391.31
7.	ANNUAL DRIVER’S CERTIFICATE OF VIOLATIONS	391.27
8.	ANNUAL REVIEW OF DRIVING RECORD	391.25
9.	CHECKLIST FOR MULTIPLE EMPLOYER	391.51(d)

*NOTE: DRIVERS MUST BE ISSUED COPIES OF THESE CERTIFICATES. DRIVERS NEED ONLY HAVE A COPY OF THE MEDICAL EXAMINER’S CERTIFICATE IN THEIR POSSESSION WHILE DRIVING.

(enter company name)

(enter address)

__________________

(enter phone number)

COMMERCIAL DRIVER APPLICATION

FILL IN ALL BLANKS & PROVIDE ALL INFORMATION REQUESTED--PRINT OR TYPE

…………………………………………………………………………………………………………………………………….

Date: _______________________

Name:	First_____________________ Middle_________________ Last______________________________________
Address _________________________________________________				Home telephone: _____________________
City_______________________ State _______ Zip ___________			Cellular telephone: _____________________
Date of Birth: ____________________________		Social Security Number: _______ - _______ - __________


If your above address is less than 3 years continue listing them below to cover the previous 3 year period:
1	Street_________________________________________________			Dates: From_________ To_________

City_______________________ State _______ Zip ___________

……………………………………………………………………………………………………………………………….

2 Street_________________________________________________ Dates: From_________ To_________

City_______________________ State _______ Zip ___________

……………………………………………………………………………………………………………………………….

3	Street_________________________________________________	Dates: From_________ To_________
	City_______________________ State _______ Zip ___________
	Use backside of sheet for additional addresses

Driver’s License Information: all licenses held, last 3 years:

State_______________ Number___________________________________________ Expiration Date _______________

Experience:
__________________________________	________________ to ________________	____________________________
Type of vehicle driven	Dates	Approximate mileage driven
__________________________________	________________ to ________________	____________________________
Type of vehicle driven	Dates	Approximate mileage driven
__________________________________	________________ to ________________	____________________________
Type of vehicle driven	Dates	Approximate mileage driven

All Accidents, last 3 years: (If none, write NONE)

Date________________ Describe_______________________________ Fatalities_____________ Injuries_____________

July2003,dlnm2

revised 08/04

List all Traffic Violations Convictions, last 3 years: (If none, write NONE)
Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No
Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No
Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No
Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No
Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No
Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No
Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No
Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No


Have you ever had any driver license denied, suspended, revoked or canceled by any issuing state agency?
	Yes	No	If yes; state of issuance; explanation: ___________________________________________________
____________________________________________________________________________________________________


Employment History, last 10 years (383.35)—account for gaps between employers: (If owner/operator, list carriers leased to)
1)	Employer:_____________________________________________			Dates: ________________to________________
	Address: _____________________________________________			Supervisor: ______________________________
	City, State, Zip code:____________________________________			Telephone: ______________________________
Were you subject to the Federal Motor Carrier Safety Regulations during this period?					Yes	No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?					Yes	No
Reason for Leaving: __________________________________________________________________________________
____________________________________________________________________________________________________

………………………………………………………………….……………………….………………………………………...
2)	Employer:_____________________________________________			Dates: ________________to________________
	Address: ___________________________________________ Supervisor:________________________________
	City, State, Zip code: ____________________________________			Telephone: ______________________________
Were you subject to the Federal Motor Carrier Safety Regulations during this period?					Yes	No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?					Yes	No
Reason for Leaving: __________________________________________________________________________________
____________________________________________________________________________________________________
………………………………………………………………….……………………….………………………………………...
						July2003,dlnm	3
						revised 08/04

3)Employer:_____________________________________________ Dates: ________________to________________

Address: _____________________________________________ Supervisor: ______________________________

City, State, Zip code: _____________________________________Telephone: ______________________________

Were you subject to the Federal Motor Carrier Safety Regulations during this period?	Yes	No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?	Yes	No

Reason for Leaving: __________________________________________________________________________________

____________________________________________________________________________________________________

………………………………………………………………….……………………….………………………………………...

4)Employer:_____________________________________________ Dates: ________________to________________

Address: _____________________________________________ Supervisor:________________________________

City, State, Zip code______________________________________ Telephone: ______________________________

Were you subject to the Federal Motor Carrier Safety Regulations during this period?	Yes	No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?	Yes	No

Reason for Leaving: __________________________________________________________________________________

____________________________________________________________________________________________________

………………………………………………………………….……………………….………………………………………...

5)Employer:_____________________________________________ Dates: ________________to________________

Address: _____________________________________________ Supervisor: ______________________________

City, State, Zip code:_____________________________________ Telephone: ______________________________

Were you subject to the Federal Motor Carrier Safety Regulations during this period?	Yes	No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?	Yes	No

Reason for Leaving: __________________________________________________________________________________

____________________________________________________________________________________________________

………………………………………………………………….……………………….………………………………………...

6) Employer:_____________________________________________ Dates: ________________to________________

Address: _____________________________________________ Supervisor: ______________________________

City, State, Zip Code:_____________________________________Telephone: ______________________________

Were you subject to the Federal Motor Carrier Safety Regulations during this period?	Yes	No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?	Yes	No

Reason for Leaving: __________________________________________________________________________________

____________________________________________________________________________________________________

………………………………………………………………….……………………….………………………………………...

revised 08/04	4
revised 08/04
July2003,dlnm

7) Employer:_____________________________________________ Dates: ________________to________________

Address: _____________________________________________ Supervisor: ______________________________

City, State, Zip code:_____________________________________ Telephone: ______________________________

Were you subject to the Federal Motor Carrier Safety Regulations during this period?	Yes	No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?	Yes	No

Reason for Leaving: __________________________________________________________________________________

____________________________________________________________________________________________________

Use backside of sheet for additional employers

For driver applicants of commercial motor vehicles that require a Commercial Driver License (CDL) the applicant must disclose their controlled substance and alcohol status per the requirements of 49 CFR part 40.25(j).

As a prospective driver employee, you have the right to review information provided by previous employers. You have the right to have errors in the information corrected by the previous employer(s) and for that previous employer(s) to re -send the corrected information to the prospective employer; the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

Driver employees who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer provided investigative information, must submit a written request to the prospective employer, which may be done at anytime, including when applying or as late as thirty (30) days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five (5) business day deadlines will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived their request to review the records.

Certification

“I certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.”

___________________________________________________________			__________________________________
Applicant’s Signature			Date Signed


TO BE COMPLETED BY THE EMPLOYER:
Application received by:		Application reviewed for completeness by:
______________________________________________		______________________________________________
Name		Name
_________________________	_______________	__________________________		_______________
Title	Date	Title		Date


SIGNIFICANT DATES:	Date of Hire:		_____________________________________
	Date of Hire:		_____________________________________
	Time & Date of Pre-Employment CST:		_____________________________________
	Time & Date of Pre-Employment CST Results Received:		_____________________________________
	Date First Used in Safety Sensitive Position:		_____________________________________
	Date of Termination:		_____________________________________

revised 08/04	5
July2003,dlnm

(enter company name)

___________________________

(enter address)

__________________

(enter phone number)

COMMERCIAL VEHICLE DRIVER APPLICANT

Controlled Substance and Alcohol Questionnaire

Pursuant to 49 CFR part 40.25(j)

…………………………………………………………………………………………………………………………………….

Application Date _______________________
Name ______________________			_______________________		______________________________________
First			Middle		Last
Address _________________________________________________					Home Telephone	_____________________
City_______________________ State _______ Zip ___________					Cell Telephone	_____________________
Date of Birth	____________________________			Social Security Number ________ - ________ - ________


				49 CFR 40.25(j)

Have you ever tested positive, or refused to test, on any pre -employment
drug or alcohol test administered by an employer to which you applied						YES	NO
for, but did not obtain, safety-sensitive transportation work covered by						YES	NO

DOT agency drug and alcohol testing rules during the past two years?

If YES —		Have you successfully completed the return-to-duty				YES	NO
If YES —		process?				YES	NO
		process?

		Documentation MUST BE PROVIDED before any				safety-sensitive
If YES —		transportation function is performed.

___________________________________________________________	__________________________________
Applicant’s Signature	Date Signed

TO BE COMPLETED BY EMPLOYER:

………………………………………………………………….……………………….………………………………………...

______________________________________________		______________________________________________
Received by:		Reviewed by:
____________________	_______________	____________________	_______________
Title:	Date:	Title:	Date:

July2003,dlnm	6
revised 08/04

The Federal Motor Carrier Safety Regulations require all previous employers of this applicant to respond to this request for information within 30 days. Failure to comply with this request is in violation of 49CFR 391.23 and 40.25, for which you may be prosecuted. Questions concerning the requirements of this regulation should be directed to the Minnesota Division Office of the Federal Motor Carrier Safety Administration at 651-291-6150, during business hours.

TO:	(enter former employer's name)
TO:	________________________________________________ DATE: _________________
	Former Employer’s Name
	(enter mailing address)
	Mailing Address
	(enter city / state / zip)
	City / State / Zip
	_____________________	(enter fax number)
	Telephone #	Fax Number

(enter name)

I, ______________________________, hereby authorize ___________________________ to release to all records of

employment, including assessments of my job performance, ability, and fitness, including the dates of any and all alcohol or drug tests, with confirmed results, and/or my refusal to submit to any alcohol and drug tests and any

rehabilitation completion under direction of Substance Abuse Professional (SAP) and/or Medical Review Officer (MRO) to each and every company (or their authorized agents) making such request in connection with my application for employment with said company. I, hereby, release the above named company, and its employees, officers, directors, and agents from any and all liability of any type as a result of providing the following information to the below mentioned person and/or company.

Applicant’s Signature & Date	_______________________________	___________________
Witness’s Signature & Date	_______________________________	___________________

REQUEST FROM:	(enter company name)
Company:	(enter company name)
Company:	_______________________________________________________
Address/City/State/Zip:	_______________________________________________________
Telephone Number:	(enter phone number) Fax Number: (enter fax number)
Contact Person & Title	_________________________________	_____________________
NAME OF APPLICANT:	_________________________________ SSN _________________
JOB APPLYING FOR:	_______________________________________________________

INQUIRY INTO EMPLOYMENT HISTORY, PRECEDING 3 YEARS

•Did applicant work for you as a ____________________________ from ____/____/____ to ____/____/____ YES or NO IF NO, please explain:

_______________________________________________________________________________

•If employed as driver, please answer the following: Company Driver? ______ Owner/Operator? ______ Other? ______

Type of truck(s) and/or truck/tractor(s) operated: ______________________________________________________

Commodities transported: ____________________________ Area of operations: ____________________________

• Accidents? YES or NO IF YES, please give date(s) and brief description of each accident:

__________________________________________________________________________________________

•Why did this employee leave your company?

__________________________________________________________________________________________

• Would you re-employ this person? YES or NO IF NO, please explain:

__________________________________________________________________________________________

•Additional comments:

__________________________________________________________________________________________

INQUIRY FOR ALCOHOL AND CONTROLLED SUBSTANCES INFORMATION, PRECEDING 2 YEARS

•
•	Alcohol tests with a result of 0.04 or greater? ……….	YES or NO	If yes, please give date(s): ________________
• Verified positive controlled substances test results? …		YES or NO	If yes, please give date(s): ________________
• Refusals to be tested? …………………………………		YES or NO	If yes, please give date(s): ________________
•	Was rehabilitation completed as required? …………...	YES or NO	If yes, please give date(s): ________________

Person providing the above information:

Name: ________________________________________________ Title: ______________________________

Company: ________________________________________________ Date: ______________________________

revised 08/04

(enter employer

name and

information

here)

Driver's Name

Driver's Operators Lic. No.

Driver's Social Sec. No.

Dear

The above listed individual has made application with us for employment as a driver. Applicant has indicated that the above numbered operator's license or permit has been issued by your State to applicant and that it is in good standing.

In accordance with Section 391.23(a)(1) and (b) of the Federal Motor Carrier Safety Regulations, we are required to make inquiry into the driving record during the preceding 3 years of every State in which an applicant-driver has held a motor vehicle operator's license or permit during those 3 years.

Therefore, please certify to us what the individual's driving record is for the preceding 3 years, or certify that no record exists if that be the case.

In the event that this inquiry does not satisfy your requirements for making such inquiries, please send us such forms of yours as are necessary for us to complete our inquiry into the driving record of this individual.

Respectfully yours,

(printed) name of person making inquiry

Title of person making inquiry

(enter company name)

Motor Carrier Name

(enter address)

Street

City

State

Zip

revised

08/04

MEDICAL EXAMINER’S CERTIFICATE

I certify that I have examined ______________________________ in accordance with the Federal Motor Carrier Safety

Regulations (49 CFR 391.41-391.49) and with knowledge of the driving rules, I find this person is qualified, and, if applicable,

only when:
wearing corrective lenses	driving within an exempt intracity zone (49 CFR 391.62)
wearing hearing aid	accompanied by a Skill Performance Evaluation Certificate (SPE)
accompanied by a ____________waiver/exemption	qualified by operation of 49 CFR 391.64

The information I have provided regarding the physical examination is true and complete. A complete examination form with any attachment embodies my findings completely and correctly, and is on file in my office.

Signature of Medical Examiner			Telephone			Date

Medical Examiner’s Name (Print)			MD	DO	Chiropractor
			Physician		Advanced
			Assistant		Practice Nurse
Medical Examiner’s License or Certificate No. / Issuing State

Signature of Driver			Driver’s License No.			State
		PLE
		M
Address of Driver

Medical Certificate Expiration Date
	SA

DRIVER’S ROAD TEST EXAMINATION

Driver’s Name: _______________________________________________________________________

Driver’s Address: _____________________________________________________________________

City: ________________________________________ State: ______________ Zip: _______________

The road test shall be given by the motor carrier or a person designated by it. However, a driver who is a motor carrier must be given the test by another person. The test shall be given by a person who is competent to evaluate and determine whether the person who takes the test has demonstrated that he or she is capable of operating the vehicle and associated equipment that the motor carrier intends to assign.

Rating of Performance
__________________	The pre-trip inspection (as required by 49 CFR 392.7).
__________________	Coupling and uncoupling of combination units, if the equipment he or she
	may drive includes combination units.
__________________	Placing the equipment in operation.
__________________	Use of vehicle’s controls and emergency equipment.
__________________	Operating the vehicle in traffic and while passing other vehicles.
__________________	Turning the vehicle.
__________________	Braking and slowing the vehicle by means other than braking.
__________________	Backing and parking the vehicle.
__________________	Other, explain: _______________________________________________

Type of equipment used in giving the test: _________________________________________________

Examiner’s signature: _____________________________________ Date: ______________________

Remarks:

If the road test is successfully completed, the person who gave it shall complete a certificate of driver’s road test.

How to Edit Driver Qualification Form Online for Free

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Step 1: To get started, click the orange button "Get Form Now".

Step 2: Once you have entered the driver qualification file form editing page you'll be able to find all the options you'll be able to perform relating to your template within the top menu.

If you want to fill out the driver qualification file form PDF, provide the information for each of the parts:

step 1 to writing dot driver qualification file checklist

Put down the details in the CHECKLIST FOR MULTIPLE EMPLOYER, NOTE DRIVERS MUST BE ISSUED COPIES, and NEED ONLY HAVE A COPY OF THE area.

dot driver qualification file checklist CHECKLIST FOR MULTIPLE EMPLOYER, NOTE DRIVERS MUST BE ISSUED COPIES, and NEED ONLY HAVE A COPY OF THE blanks to fill out

You will be required to enter the data to help the program fill in the field COMMERCIAL DRIVER APPLICATION FILL, Date, Name First Middle Last, Address Home telephone, City State Zip Cellular, Date of Birth, Social Security Number, If your above address is less than, Street, Dates From To, and City State Zip.

stage 3 to filling out dot driver qualification file checklist

You'll have to identify the rights and responsibilities of all parties in section Street, Dates From To, City State Zip, Street, Dates From To, City State Zip, Use backside of sheet for, Drivers License Information all, State Number Expiration Date, State Number Expiration Date, State Number Expiration Date, and Experience.

Finishing dot driver qualification file checklist step 4

Review the fields Type of vehicle driven, Dates, Approximate mileage driven, Type of vehicle driven, Dates, Approximate mileage driven, Type of vehicle driven, Dates, Approximate mileage driven, All Accidents last years If none, Date Describe Fatalities Injuries, Date Describe Fatalities Injuries, Date Describe Fatalities Injuries, and July dlnm and next fill them in.

step 5 to completing dot driver qualification file checklist

Step 3: Choose the Done button to confirm that your completed document can be transferred to every device you prefer or mailed to an email you indicate.

Step 4: Generate a minimum of several copies of the form to remain away from any kind of upcoming troubles.

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