Driver qualification forms are an important part of keeping your business safe and in compliance with state laws. This form lists the requirements for driving for your company, and is used to verify that each driver has met those requirements. By having a driver qualification form, you can be sure that all of your drivers are qualified to operate a vehicle for your company. The form should list things like the driver's age, license type and expiration date, insurance information, and any other applicable qualifications. You can find templates for driver qualification forms online or create your own using a word processing program. Whichever route you choose, be sure to keep a copy of the completed form on file for each driving employee.
Here are some details you might like to consider before you begin working with the driver qualification form.
Question | Answer |
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Form Name | Driver Qualification Form |
Form Length | 12 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 3 min |
Other names | dot driver qualification file checklist 2020, driver qualification file form, driver qualification file checklist 2019 forms, driver qualification file packet |
DRIVER QUALIFICATION FILE
CHECKLIST
1. |
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DRIVER APPLICATION FOR EMPLOYMENT |
391.21 |
2. |
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INQUIRY TO PREVIOUS EMPLOYERS (3 YEARS) |
391.23(a)(2) & (c) |
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INQUIRY TO STATE AGENCIES |
391.23(a)(1) & (b) |
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MEDICAL EXAMINER’S CERTIFICATE* |
391.43 |
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(MEDICAL WAIVER, IF ISSUED) |
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5. |
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DRIVER’S ROAD TEST |
391.31 |
6. |
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CERTIFICATION OF ROAD TEST* |
391.31 |
7. |
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ANNUAL DRIVER’S CERTIFICATE OF VIOLATIONS |
391.27 |
8. |
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ANNUAL REVIEW OF DRIVING RECORD |
391.25 |
9. |
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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.
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(enter company name)
(enter address)
__________________
(enter phone number)
COMMERCIAL DRIVER APPLICATION
FILL IN ALL BLANKS & PROVIDE ALL INFORMATION
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Date: _______________________
Name: |
First_____________________ Middle_________________ Last______________________________________ |
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Address _________________________________________________ |
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Home telephone: _____________________ |
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City_______________________ State _______ Zip ___________ |
Cellular telephone: _____________________ |
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Date of Birth: ____________________________ |
Social Security Number: _______ - _______ - __________ |
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If your above address is less than 3 years continue listing them below to cover the previous 3 year period: |
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Street_________________________________________________ |
Dates: From_________ To_________ |
City_______________________ State _______ Zip ___________
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2 Street_________________________________________________ Dates: From_________ To_________
City_______________________ State _______ Zip ___________
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Street_________________________________________________ |
Dates: From_________ To_________ |
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City_______________________ State _______ Zip ___________ |
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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: |
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________________ to ________________ |
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Type of vehicle driven |
Dates |
Approximate mileage driven |
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________________ to ________________ |
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Type of vehicle driven |
Dates |
Approximate mileage driven |
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________________ 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) |
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Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No |
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Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No |
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Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No |
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Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No |
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Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No |
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Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No |
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Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No |
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Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No |
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Have you ever had any driver license denied, suspended, revoked or canceled by any issuing state agency? |
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Yes |
No |
If yes; state of issuance; explanation: ___________________________________________________ |
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____________________________________________________________________________________________________ |
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Employment History, last 10 years |
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1) |
Employer:_____________________________________________ |
Dates: ________________to________________ |
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Address: _____________________________________________ |
Supervisor: ______________________________ |
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City, State, Zip code:____________________________________ |
Telephone: ______________________________ |
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Were you subject to the Federal Motor Carrier Safety Regulations during this period? |
Yes |
No |
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Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period? |
Yes |
No |
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Reason for Leaving: __________________________________________________________________________________ |
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____________________________________________________________________________________________________ |
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………………………………………………………………….……………………….………………………………………... |
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2) |
Employer:_____________________________________________ |
Dates: ________________to________________ |
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Address: ___________________________________________ Supervisor:________________________________ |
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City, State, Zip code: ____________________________________ |
Telephone: ______________________________ |
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Were you subject to the Federal Motor Carrier Safety Regulations during this period? |
Yes |
No |
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Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period? |
Yes |
No |
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Reason for Leaving: __________________________________________________________________________________ |
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____________________________________________________________________________________________________ |
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………………………………………………………………….……………………….………………………………………... |
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July2003,dlnm |
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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 |
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July2003,dlnm |
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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
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.”
___________________________________________________________ |
__________________________________ |
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Applicant’s Signature |
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Date Signed |
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TO BE COMPLETED BY THE EMPLOYER: |
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Application received by: |
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Application reviewed for completeness by: |
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Name |
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Date |
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SIGNIFICANT DATES: |
Date of Hire: |
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Time & Date of |
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Time & Date of |
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Date First Used in Safety Sensitive Position: |
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Date of Termination: |
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_____________________________________ |
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)
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Application Date _______________________ |
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Name ______________________ |
_______________________ |
______________________________________ |
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First |
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Middle |
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Last |
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Address _________________________________________________ |
Home Telephone |
_____________________ |
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City_______________________ State _______ Zip ___________ |
Cell Telephone |
_____________________ |
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Date of Birth |
____________________________ |
Social Security Number ________ - ________ - ________ |
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49 CFR 40.25(j) |
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Have you ever tested positive, or refused to test, on any pre |
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drug or alcohol test administered by an employer to which you applied |
YES |
NO |
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for, but did not obtain, |
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DOT agency drug and alcohol testing rules during the past two years? |
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If YES — |
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Have you successfully completed the |
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NO |
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process? |
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Documentation MUST BE PROVIDED before any |
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If YES — |
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transportation function is performed. |
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___________________________________________________________ |
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Applicant’s Signature |
Date Signed |
TO BE COMPLETED BY EMPLOYER:
………………………………………………………………….……………………….………………………………………...
______________________________________________ |
______________________________________________ |
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Received by: |
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Reviewed by: |
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____________________ |
_______________ |
____________________ |
_______________ |
Title: |
Date: |
Title: |
Date: |
July2003,dlnm |
6 |
revised 08/04 |
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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
TO: |
(enter former employer's name) |
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________________________________________________ DATE: _________________ |
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Former Employer’s Name |
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(enter mailing address) |
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Mailing Address |
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(enter city / state / zip) |
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City / State / Zip |
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_____________________ |
(enter fax number) |
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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 |
_______________________________ |
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Witness’s Signature & Date |
_______________________________ |
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REQUEST FROM: |
(enter company name) |
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Company: |
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Address/City/State/Zip: |
_______________________________________________________ |
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Telephone Number: |
(enter phone number) Fax Number: (enter fax number) |
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Contact Person & Title |
_________________________________ |
_____________________ |
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NAME OF APPLICANT: |
_________________________________ SSN _________________ |
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JOB APPLYING FOR: |
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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
__________________________________________________________________________________________
•Additional comments:
__________________________________________________________________________________________
INQUIRY FOR ALCOHOL AND CONTROLLED SUBSTANCES INFORMATION, PRECEDING 2 YEARS
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Alcohol tests with a result of 0.04 or greater? ………. |
YES or NO |
If yes, please give date(s): ________________ |
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• Verified positive controlled substances test results? … |
YES or NO |
If yes, please give date(s): ________________ |
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• Refusals to be tested? ………………………………… |
YES or NO |
If yes, please give date(s): ________________ |
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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
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)
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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
only when: |
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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 |
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Medical Examiner’s Name (Print) |
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MD |
DO |
Chiropractor |
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Physician |
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Advanced |
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Assistant |
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Practice Nurse |
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Medical Examiner’s License or Certificate No. / Issuing State |
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Signature of Driver |
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Driver’s License No. |
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Address of Driver |
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Medical Certificate Expiration Date |
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SA |
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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 |
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The |
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Coupling and uncoupling of combination units, if the equipment he or she |
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may drive includes combination units. |
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Placing the equipment in operation. |
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Use of vehicle’s controls and emergency equipment. |
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Operating the vehicle in traffic and while passing other vehicles. |
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Turning the vehicle. |
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Braking and slowing the vehicle by means other than braking. |
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Backing and parking the vehicle. |
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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.
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