Form Driver Statement – Fill Out and Use This PDF

DF - 6

DRIVER STATEMENT OF ON-DUTY HOURS

(For Newly Hired Drivers)

INSTRUCTION: Motor carriers when using a driver for the first time shall obtain from the driver a signed statement giving the total time on-duty during the immediately preceding 7 days and time at which such driver was last relieved from duty prior to beginning work for such carrier. Rule 395.8(j)(2) Federal Motor Carrier Safety Regulations. NOTE: Hours for any compensated work during the preceding 7 days, including work for a non-motor carrier entity, must be recorded on this form.

Driver Name (Print) _________________________________________________________________________________

Social Security Number _____________________________________________________________________________

Driver’s License: State _____ Number _________________ Class _____ Endorsement(s) ______ Restriction(s) _______

Type of License __________________________________ Issuing State ______________________________________

DAY	1	2	3		4	5		6		7
	(yesterday)
DATE
HOURS											TOTAL HOURS
WORKED
	I hereby certify that the information given above is correct to the best of my
	knowledge and belief, and that I was last relieved from work at
			A.M.
	___________________ P.M.			On _________________________________

Time	Day	Month	Year
_____________________________________________		______________
	Driver’s Signature		Date

_________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DRIVER CERTIFICATION FOR OTHER COMPENSATED WORK

INSTRUCTIONS: When employed by a motor carrier, a driver must report to the carrier all on-duty time including time working for other employers. The definition of on-duty time found in Section 395.2 paragraphs (8) and (9) of the Federal Motor Carrier Safety Regulations includes time performing any other work in the capacity of, or in the employ or service of, a common, contract or private motor carrier, also performing any compensated work for any nonmotor carrier entity.

	(check one)
Are you currently working for another employer?	□ Yes	□ No
At this time do you intend to work for another employer while still employed by	□ Yes	□ No
this company?

I hereby certify that the information given above is true and I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity.

	____________________________________________	________________
	Driver’s Signature	Date
Witness:	____________________________________________	________________
	Company Representative	Date