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Driver Application for Employment
Certification of Compliance with Drivers License Requirements
Driver Notification and Release
Request for Information from Previous Employer
Driver Data Sheet
Certified Driver’s Receipt for NON-DOT Driveres
Authorization to Release Information
Hours of Service Training Log
Drivers Quiz
Driver Data Sheet
Name
(Required)
Social Security Number
(Required)
Motor Vehicle Operator's License Number
(Required)
Type of License
(Required)
Issuing State
(Required)
Instructions: Motor carriers when using a driver for the first time or intermittently 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.
Day 1 Date
(Required)
Month
Day
Year
Hours Worked
(Required)
Day 2 Date
(Required)
Month
Day
Year
Hours Worked
(Required)
Day 3 Date
(Required)
Month
Day
Year
Hours Worked
(Required)
Day 4 Date
(Required)
Month
Day
Year
Hours Worked
(Required)
Day 5 Date
(Required)
Month
Day
Year
Hours Worked
(Required)
Day 6 Date
(Required)
Month
Day
Year
Hours Worked
(Required)
Day 7 Date
(Required)
Month
Day
Year
Hours Worked
(Required)
Hire Date
(Required)
MM slash DD slash YYYY
I hereby certify the information given above is correct to the best of my knowledge and belief, and that I was last relieved from work at
(Required)
On
(Required)
Month
Day
Year
Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Witness Signature _____________________________. Date: _________________________
Employment Check List for Intermittent, Casual, or Occasional Driver
The qualification file for an intermittent, casual, or occasional driver employed under Sec.391.63 must include the following forms as per Section 391.51{d} Federal Motor Carrier Safety Regulations.
1. Medical Examiner’s Certificate – The medical examiner’s certificate of his physical qualification to drive a motor vehicle or a legible photographic copy of the certificate pursuant to Sec. 391.43.
2. Certificate of Driver’s Road Test – The certificate of driver’s road test issued to the driver pursuant to Sec.391.31{e}, or a copy of the license or certificate which the motor carrier accepted as equivalent to the driver’s road test pursuant to Sec.391.31.
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