Driving Record Filler Form PDF Details

If you are like most people, you probably don't think about your driving record until you need it for something. A new driver's license, car insurance, or employment application usually requires a copy of your driving history. You can get a copy of your driving record from the DMV, but did you know there is also another way to obtain it? Drivingrecordfiller.com is a website that allows you to fill out and submit a form to request your driving record. There is no fee to use this service, and the process only takes a few minutes. Plus, the site is secure and easy to use. So if you need a copy of your driving record for any reason, be sure to check out Drivingrecordfiller.com!

QuestionAnswer
Form NameDriving Record Filler Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdiesel record fill, record filler form, driving filler, record filler

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MOTOR VECHICLE DRIVER’S CERTIFICATION OF VIOLATIONS/ANNUAL REVIEW OF DRIVING RECORD

MOTOR CARRIER INSTRUCTIONS: Each motor carrier shall at least once every 12 months, require each driver it employs to prepare and furnish it with a list of all violations of motor vehicle traffic laws and ordinances (other than violations involving only parking) of which the driver has been convicted, or on account of which he/she has forfeited bond or collateral during the preceding 12 months (Section 391.27). Drivers who have provided information required by Section 383.31 need not repeat that information on this form.

DRIVER REQUIREMENTS: Each driver shall furnish the list as required by the motor carrier above. If the driver has not been convicted of, or forfeited bond or collateral on account of any violation which must be listed, he/she shall so certify (Section 391.27).

COMPLETED BY DRIVER – CERTIFICATION OF VIOLATIONS

NAME OF DRIVER: (PRINT)

SOCIAL SECURITY NUMBER

DATE OF EMPLOYMENT

 

 

 

HOME TERMINAL (CITY AND STATE)

DRIVER’S LICENSE NUMBER / STATE

EXPIRATION DATE

 

 

 

I certify that the following is a true and complete list of traffic violations required to be listed (other than those I have provided under Part 383) for which I have been convicted or forfeited bond or collateral during the past 12 months.

 

(If you have had no violations, check the following box - None.)

DATE

OFFENSE

LOCATION

TYPE OF VEHICLE OPERATED

________________

______________________

_________________________ __________________________

________________

______________________

_________________________ __________________________

________________ _______________________

_________________________ __________________________

________________ _______________________

_________________________ _________________________

________________ _______________________

_________________________

_________________________

If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation (other than those I have provided under Part 383) required to be listed during the past 12 months.

(Today’s Date)

Date of Certification ____________________ Driver’s Signature _____________________________________

COMPLETED BY MOTOR CARRIER – ANNUAL REVIEW OF DRIVING RECORD

MOTOR CARRIER INSTRUCTIONS: Review the Certification of Violations listed above and other information described in Section 391.25 of the Federal Motor Carrier Safety Regulations. Complete the information requested below.

I have hereby reviewed the driving record of the above named driver in accordance with Section 391.25 and find that he/she (check one):

Meets minimum requirements for safe drivingIs disqualified to drive a motor vehicle pursuant to Section 391.15 Does not adequately meet satisfactory safe driving performance

Action taken with driver: _______________________________________________________________________________________

___________________________________________________________________________________________________________

Reviewed by:______________________________________________________________ Date____________________________

Signature

__________________________________________________________

Printed Name

Ace Doran Hauling & Rigging, 1601 BLUE ROCK STREET, CINCINNATI, OHIO 45223 800-829-0929