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.

QuestionAnswer
Form NameDriver Qualification Form
Form Length12 pages
Fillable?No
Fillable fields0
Avg. time to fill out3 min
Other namesdriver qualification form, driver qualification file forms, driver list template, dot driver qualification file checklist

Form Preview Example

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.

1

(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 _______________

State_______________ Number___________________________________________ Expiration Date _______________

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_____________

Date________________ Describe_______________________________ Fatalities_____________ Injuries_____________

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

 

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:

 

_____________________________________

 

 

 

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

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

If YES —

 

Have you successfully completed the return-to-duty

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)

 

________________________________________________ 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:

_______________________________________________________

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

7

(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

8

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

 

 

 

 

9

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.

10

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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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