SETTING UP AND MAINTAINING



PROPERLY QUALIFYING DRIVERS & SETTING UP AND MAINTAINING DRIVER QUALIFICATION FILES ByMatthew DaecherThe Daecher Consulting GroupINTRODUCTIONCompanies operating commercial vehicles are required by the USDOT to maintain a Driver Qualification File (DQF) for each commercial motor vehicle (CMV) operator. The requirements for a DQF are spelled out in the Federal Motor Carrier Safety Regulations (FMCSRs). While the FMCSRs only apply to interstate CMV drivers, it is important to note that the vast majority of states adopt the FMCSRs as their state safety regulations for intrastate CMV drivers. While minor changes are often made to the FMCSRs for intrastate regulatory purposes, the driver qualification regulations are most often unchanged.It is important that companies who operate commercial vehicles comply with the FMCSRs and applicable state regulations to avoid potential issues with non-compliance, including fines and other actions against operating authority. Another compelling reason to comply with these and other applicable regulations revolves around legal actions, which may arise out of collision claims. In today’s litigious environment, driver qualification files are usually acquired by opposing parties in legal actions related to accidents. Adverse parties will be quick to point out any errors in the driver qualification file and may be able to increase the value of claims, including asking for punitive damages, if they can establish that the motor carrier was negligent in hiring a driver or negligent in their duties to qualify the driver according to regulatory standards. Properly qualifying a driver as opposed to simply going through the motions of gathering required paperwork can mean a world of difference when it comes to lawsuits and claim values.Changing regulations sometimes result in changes to the way drivers should be qualified, and, consequently, how the DQF should be set up, maintained, and what it should include. This packet is designed to help a company understand the most recent regulatory requirements for a DQF and also to suggest ways to “bulletproof” your driver qualification file/process from any aggressive plaintiff parties after a collision.I’ve tried to put this together in a self-explanatory way – all it should take to truly understand DQFs and understand a simple way to assemble and maintain them is a little time invested by you. There is a description and background for each form in the narrative and a corresponding example of most in one of the Appendices.Section 1.1SECTION ONEINITIAL DRIVER QUALIFICATION FILE DOCUMENTS & PROCESSESThe following forms and processes should be executed/completed at the time a driver is hired. The forms completed and items gathered in relation to this section should be maintained indefinitely in the Driver Qualification File.THE EMPLOYMENT APPLICATIONSection 1.2The first encounter with a potential driver often revolves around completion of an Employment Application. This also one of the most common problems observed in DQFs – applications which do not meet regulatory standards or are not completed and reviewed thoroughly. The following steps should be completed in the application/interview process:Use a regulatory compliant Employment Application. The FMCSRs require specific information to be collected on a CMV driver application and also specify language to be used for certain areas of the application. Most generic or even customized employment applications do not meet these regulatory standards if they have not been developed specifically for a CMV driver hire. After the applicant completes the application, review it for completeness. Specifically:Ensure that all areas of the application are competed/inquiries are answered. If there is no response for a specific inquiry (such as “CMV Driving Experience”), the applicant should write “N/A” in the response area.Ensure that a complete employment history for the previous three years is provided. If there are gaps in employment in the previous three years of employment history provided, the employer should require the applicant to provide an explanation of the gaps (i.e., what they were doing during those periods). Explanations should either be provided by the applicant in writing and attached to the original application, or interview notes documenting the applicant explanations should be written and attached to the application.If you have been provided a resume or similar documents prior to completion of the application, ensure that the work history and any other data contained in both are consistent.A regulatory compliant application is included in Appendix A.The completed employment application must be maintained indefinitely in the DQF.Section 1.3APPLICANT MOTOR VEHICLE RECORD (MVR)Employers are required by the FMCSRs to obtain an applicant’s MVR from each state where the applicant held a driver license within the previous three years from the date of the application. The MVR must include a minimum of 3 years of driving history (every state MVR contains at least 3 years of driver record information – some states have options that make more data available to employers if requested). There are generally three methods of acquiring a driver MVR:Send an inquiry to the license-issuing state agency responsible for driver records requesting an MVR for the applicant. This generally requires an authorization from the applicant, state-specific forms for requesting the MVR, and payment in the amount of whatever the state charges for the MVR. Many states have options to acquire a record electronically, which is quicker and more efficient. The process for acquiring them directly from state agencies varies widely, so a more complete description of the process cannot be offered in this general overview.Have the applicant provide you with their MVR(s). If you choose to go this route, be sure that the report date on the MVR provided is no more than one week prior to the application date. Use a third party to obtain the necessary MVR(s). Companies specializing in obtaining employment and personal data (some online) are available to aid in acquiring driver MVRs from various states. Whichever method is used to obtain the initial MVR, there are several things you should do once you receive the applicant MVR(s):Review the MVR to ensure that the “report” date reflects when it was ordered/processed and that this date coincides closely with the application for employment.Review the MVR to ensure that no disqualifying violations have occurred (as specified in the FMCSRs – see “Disqualifying Offenses” in Appendix A).Compare violations and/or revocation periods listed on the MVR with those listed on the applicant’s application. If there are differences, these should be explained by the applicant, with the explanation documented and attached to the application. An applicant’s blatant failure to be truthful on the application should be carefully considered by the employer in the hiring decision. Ensure the MVR indicates that all necessary endorsements (passenger, air brakes, etc.) necessary are valid.Note the license issuance date noted on the MVR. If this date is less than three years from the date of the application, the applicant may have had held a previous license issued in another state for which you must obtain another MVR (issued by previous Section 1.4state). On the application, the applicant is required to list any states where a license was held within three years of the date of the application, however, they do not always do so. If the MVR reveals that the license was issued less than three year from the date of the application, an inquiry should be made to the applicant regarding any previously held licenses, his/her response documented and attached to the MVR, and any actions taken if necessary (do you need to obtain an MVR from another state?) An initial issuance date in close proximity to the application may also indicate a driver with limited driving experience (recently licensed).Note the expiration date of the license. You will need to know this going forward should you hire the applicant so that you can ensure that the license is renewed in a timely fashion while the driver is employed by you.The MVR obtained in connection with an applicant’s application for employment should be retained indefinitely in the DQF.Section 1.5PHYSICAL QUALIFICATION & MEDICAL EXAMINATION/CERTIFICATION OF PHYSICAL EXAMINATIONCMV drivers are required to meet certain physical qualification criteria as defined in the FMCSRs to operate CMVs. Documentation of drivers meeting the qualification criteria is required to be kept in the DQF. Additionally, drivers are required to keep, on their person, evidence of being medically qualified to operate a CMV (currently, physically cards will no longer be required as of June 21, 2021).Determination of whether an individual meets the established physical qualification criteria is made by a licensed medical examiner via a medical examination. Specific forms to be used in conducting physical examinations are specified in the FMCSRs. Examinations must be conducted by an examiner certified and listed on the National Registry of Certified Medical Examiners. Once a person passes a DOT-specific medical exam and is physically qualified to operate a CMV, he/she is issued a medical examiners certificate which indicates that the person on the certificate meets DOT-specified physical qualification criteria and is medically certified to operate a CMV until the date of the expiration listed on the medical examiners certificate. Companies should do the following with respect to driver medical certifications:As applicable, ensure the updated medical certification information is submitted to the state driver licensing agency so that medical information can be updated on the driver’s MVR (eventually states will obtain this information directly from medical examiners);Retain the medical examiner’s certificate, or a photocopy thereof, in the DQFFor CDL-licensed drivers –obtain an MVR from the state within 15 days of a driver successfully passing the examination. Companies must check the MVR to ensure that the updated medical certification is listed on the MVR. As indicated above, the driver should carry their medical certification card with them while operating a CMV through June 21, 2021. The length of physical qualification once a person successfully passes the medical examination depends on the results of the exam and may also be limited by state regulations. While the minimum qualification period varies, the maximum medical qualification period is two years. Employers may accept a currently valid medical examiners certificate presented by an applicant as proof of physical qualification to drive CMVs. However, we strongly suggest that employers require applicants to undergo and pass a medical examination performed by a company-designated licensed medical examiner, regardless of the current status of the applicant with regard to physical qualification as evidenced by a medical examiner certificate. A sample of the medical examiner certificate is included in Appendix A.For ease of recordkeeping, the original medical examiner certificate (time of hire) should be maintained indefinitely in the DQF.PRE-EMPLOYMENT CONTROLLED SUBSTANCE TESTSection 1.6&CERTIFICATION OF PRIOR PRE-EMPLOYMENT CONTROLLED SUBSTANCE TEST RESULTSPre-Employment Controlled Substance TestPrior to the first time a CDL-licensed driver performs safety-sensitive functions for an employer, he/she must undergo testing for controlled substances. No employer can allow a driver to perform safety-sensitive functions unless the employer has received a verified negative test result for that driver.There are limited exceptions where a prospective employer could forgo this requirement, however, it simply makes more sense and is more practical to have the applicant pre-employment tested in all cases.The notification of a verified negative test result for the applicant should be maintained indefinitely in the DQF.Certification of Prior Pre-employment Controlled Substance Test ResultsIn addition to conducting your own pre-employment controlled substance test, a prospective employer must ask each applicant information regarding their performance on previous pre-employment tests for other potential employers ain the previous two years. Specifically, you must ask the applicant to certify that they have not (or have) tested positive in these situations. Compliance with this regulation (40.25j) is sometimes accomplished via an additional sign-off/acknowledgment included in the hiring process paperwork. However, it can also be included in the Application for Employment itself. In this guide, we have included this question on the Application for Employment, and, if using the Application in the Appendix, any other documentation is unnecessary. However, if you have a current Application for Employment you would like to continue using, you simply need to add the following wording to that current Application or use an entirely separate document to accomplish this inquiry:“Have you tested positive or refused to test in any pre-employment controlled substance or alcohol tests in situations where you did not obtain employment within the previous two years?”YesNoRECORD/CERTIFICATE OF ROAD TEST OR EQUIVALENTSection 1.7CMV driver applicants are required to pass a road test conducted by the prospective employer before the employer can permit the applicant to operate CMVs. After successful completion of the road test, the carrier/employer who gave it must issue a certificate of road test in accordance with 391.31(e). The road test should be of sufficient duration to enable the person who gives it to evaluate the skill of the driver at handling the vehicle and associated equipment that the company intends the applicant to operate. At a minimum, the applicant should be tested on his/her skill at performing each of the following operations:The pre-trip inspection;Coupling and uncoupling of combination units, if the equipment he/she may drive includes combination units;Placing the commercial motor vehicle in operation;Use of the commercial motor vehicle's controls and emergency equipment;Operating the commercial motor vehicle in traffic and while passing other motor vehicles;Turning the commercial motor vehicle;Braking, and slowing the commercial motor vehicle by means other than braking; andBacking and parking the commercial vehicle.The company must provide a road test form on which the evaluator rates the performance of the driver, and the evaluator must sign the form following completion. Most generic road test forms on the market meet the requirements in both subject matter and documentation. When conducting a road test to meet the requirements of this section, a certificate of road test must also be issued. These documents must be maintained indefinitely on the DQF.For vehicles where a CDL is necessary, as an alternative to conducting and documenting a road test exam and completing a certificate of road test as noted above, a company may accept a currently valid CDL with the proper endorsements necessary for operating the specific type of CMV the applicant is intended to operate. If a company accepts a currently valid and properly endorsed CDL in lieu of conducting and documenting the road test, a legible copy of the driver license must be permanently maintained in the DQF.Even if a road test is conducted and a certificate of road test issued, we suggest that a current copy of the driver’s license is maintained in the DQF.Example of a road test exam form and a certificate of road test are included in Appendix A.These forms should be maintained indefinitely in the DQF.LETTER OF AUTHORIZATIONSection 1.8& RIGHTS REGARDING INVESTIGATIVE INFORMATIONPotential employers are required to make specific inquiries and perform specific investigations when considering a CMV driver applicant for hire. In order to perform some of these inquiries and investigations, express authorization from the applicant is required. A company may not permit any driver who refuses to provide such authorization to drive a CMV.Potential employers are also required to expressly inform applicants of specific rights related to the accuracy of information furnished by previous employers in response to required inquiries. A suggested “Letter of Authorization & Notification of Rights” is included in Appendix A.This completed form should be maintained indefinitely in the DQF.PREVIOUS EMPLOYER INVESTIGATIONS & INQUIRIESSection 1.9Regulations require employers to perform specific investigations and inquiries into an applicant’s previous employment record. Access to the information received from these inquiries should be maintained in the DQF and DQFs should have controlled access. Employers must perform the following tasks (eff. 10/29/04):For any applicant who has driven a CMV for an employer regulated by the DOT within the past three years from the date of the application, employers must, at a minimum, make the following inquiries:Verification of provided employment timeframe and driving tasks;Information relative to any DOT-recordable accidents which occurred in the past three years. The information requested must include: Date of the accident; City/town and state where the accident occurred; Number of injuries; Number of fatalities; and Whether hazardous materials other than fuel were released as a result of the accident.Any accidents the previous employer may wish to provide that are retained pursuant to the employer's internal policies for retaining more detailed minor accident informationFor any CDL-licensed applicant who was employed in a safety-sensitive position which required drug and alcohol testing for an employer regulated by any DOT agency/administration within the past three years from the date of the application, employers must make the following inquiries:Whether, within the previous three years, the driver had violated the alcohol and controlled substances prohibitions contained in the FMCSRs;Whether the driver failed to undertake or complete a rehabilitation program prescribed by a substance abuse professional (SAP) pursuant to requirements in the FMCSRs. If the previous employer does not know this information (e.g., an employer that terminated an employee who tested positive on a drug test), the prospective employer must obtain documentation of the driver's successful completion of the SAP's referral directly from the driver.For a driver who has successfully completed a SAP's rehabilitation referral, and remained in the employ of the referring employer, information on Section 1.10whether the driver had the following testing violations subsequent to completion of the rehabilitation program:Alcohol tests with a result of 0.04 or higher alcohol concentration;Verified positive drug tests; orRefusals to be tested (including verified adulterated or substituted drug test results).For previous employers who were regulated by FMCSA, this inquiry will no longer be required as of January 6, 2023 due to the implementation of the Drug & Alcohol Clearinghouse.For driver applicants with no previous employment experience working for a DOT-regulated employer during the preceding three years, documentation that no investigation was possible must be placed in the driver qualification file.Regulations require that potential employers make a good faith effort to obtain the required information from previous employers and that such efforts be documented. Requests for information from previous employers must be documented in the DQF within 30 days of an applicant’s hire. Responses received from previous employers should be placed in the DQF as soon as practical after receipt. Previous employers are required by regulation to respond to appropriate inquiries within 30 days of receipt of the requests for information. Previous employers who do not respond to required inquiries should be reported to the Assistant Administrator of the FMCSA.Inquiries and investigations required by this regulation are the minimum requirements. We strongly suggest that, as a company policy, efforts to verify employment and similar performance history for the previous three years also be attempted with previous employers who were not DOT-regulated or where the applicant did not drive a CMV or was not employed in a safety-sensitive position. The only difference between these additional investigations and those regulated would be that the previous employer would not be required by regulation to respond to such inquiries.A “Safety Performance History Records Request”, which accomplishes all regulatory requirements in this area when sent to applicable previous employers, has been included in Appendix A. The easiest way to ensure that you are complying with all regulations in this area is to send one of these forms to each previous employer of the applicant within three years of the date of the application. After completion and conveyance to previous employers, these forms should be maintained indefinitely in the DQF. If/when completed forms with required information are received back from previous employers, we suggest the form be stapled to the original form sent to the corresponding previous employer and maintained indefinitely in the DQF.A self-explanatory form to report previous employers who fail to respond to required inquiries is also included in Appendix A.Section 1.11DRUG & ALCOHOL CLEARINGHOUSE INQUIRY Effective January 6, 2020, employers hiring CDL-licensed (or Commercial Learner’s Permit-licensed) drivers must conduct an information query in the Drug & Alcohol Clearinghouse () utilizing the applicant’s information. In order to make queries in the Drug & Alcohol Clearinghouse (Clearinghouse), employers must have a registered account. Additionally, driver applicants must also have an account in the Clearinghouse. Accounts are free to set up for all Clearinhouse users. A query plan must be purchased by the employer/carrier to conduct required inquiries, while drivers have free access to their information.There are two types of possible queries to the Clearinghouse – limited and full. Driver consent is required before an employer/potential employer makes an inquiry. Employers making inquiries for new driver applicants must complete a full query, which requires electronic consent by the applicant driver. The electronic consent is conducted through the driver’s account in the Clearinghouse, and the results of the query will not be provided to the employer until consent is granted through the driver’s account.Employers can designate consortias or third party administrator/agents (C/TPA) to act on their behalf in conducting Clearinghouse inquiries, though employers remain ultimately accountable to ensure that inquiries are made as required. To allow such, both the employer and the C/TPA must have an account in the Clearinghouse and the employer must designate in their account any C/TPA authorized to act on their behalf.CERTIFICATE OF COMPLIANCE WITH DRIVERS LICENSE REQUIREMENTSSection 1.12No employer may knowingly allow, require, permit, or authorize a driver to operate a CMV in the United States:During any period in which the driver has a CMV driver's license suspended, revoked, or canceled by a State, has lost the right to operate a CMV in a State, or has been disqualified from operating a CMV;During any period in which the driver has more than one CMV driver's license;During any period in which the driver, or the CMV he or she is driving, or the motor carrier operation, is subject to an enforcement official’s out-of-service order; orIn violation of a Federal, State, or local law or regulation pertaining to railroad-highway grade crossings.The “Certificate of Compliance with Drivers License Requirements” form in Appendix A is designed to inform the driver of their obligations with regards to some of the above relevant regulations. This form should be maintained indefinitely in the DQF.DRIVER STATEMENT OF ON-DUTY HOURSSection 1.13&CERTIFICATION OF OTHER COMPENSATED WORKMotor carriers/employers, when using a driver for the first time or intermittently, must obtain from the driver a signed statement giving the total time on duty during the immediately preceding 7 days and the time at which the driver was last relieved from duty prior to beginning work for the motor carrier/employer. This is required so that the employer has knowledge of the work history required to assure that the driver is in compliance with Hours of Service regulations when they first operate a CMV for the company.Carriers are also required to keep track of employees compensated work outside of work performed for the motor carrier. The “Drivers Certification of Other Compensated Work” establishes whether, at the time of hire, the applicant performs such work elsewhere, which will aid you in understanding if you must track employment outside of that which the driver performs for you. This form also certifies that, if outside or additional employment is gained, the driver will notify the employer.An example of this combined form is included in Appendix A. This form should be maintained indefinitely in the DQF.WAIVERS OF PHYSICAL DISQUALIFICATIONSection 1.14There are specific criteria of physical disqualification that can be waived through a proper application process with the FMCSA. Most employers never have to deal with this topic, but, if you do have a driver that has been granted a waiver of a disqualifying physical criteria, you must obtain the letter issued by the Field Administrator, Division Administrator, or State Director of the FMCSA granting the physical waiver. Waiver letters must be maintained indefinitely in the DQF.More information on physical qualification waivers can be found in 49 CFR 391.49.Section 2.1SECTION TWODRIVER QUALIFICATION FILE MAINTENANCE/RECURRING PROCESSESThere are a few recurring processes which must be performed to keep a Driver Qualification File in compliance with regulations. This section outlines our recommendations for maintaining the files and complying with the regulations.ANNUAL MVR/CERTIFICATION OF VIOLATIONS/REVIEW OF DRIVING RECORDSection 2.2This is actually three separate processes which regulations require to be performed once every twelve months.Annual MVR – Each carrier must, at least once every 12 months, make an inquiry into the driving record of each driver it employs to the appropriate agency of every State in which the driver held a commercial motor vehicle operator's license or permit during the time period. The inquiry must detail any convictions for at least the last 12 months.Simply put, this requires you to obtain an MVR once every twelve months for each CMV driver. This MVR must be retained in the DQF for at least three years. The options for obtaining MVRs are detailed in Section One. It is worth noting that many insurance companies and/or insurance agents obtain an annual MVR on insured carrier’s drivers. If this is the case, your insurer or agent may be willing to submit these MVRs to you for use in complying with this regulation.Annual Certification of Violations - 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.This requires you, once every 12 months, to have each CDL-licensed driver complete a form listing any moving violations of which they have been convicted. Annual Review of Driving Record - Each motor carrier must, at least once every 12 months, review the driving record of each driver it employs to determine whether that driver meets minimum requirements for safe driving or is disqualified to drive a commercial motor vehicle pursuant to 391.15.This regulation requires written documentation of an annual review of each driver’s annually acquired MVR by management personnel to ensure that the driver has not been convicted of any offenses which would disqualify them from driving a commercial vehicle (as listed in . Most likely, they haven’t, and, if they had, you’d probably (hopefully) not use them as driver anyway). In any case, the MVR must be reviewed for these offenses as being convicted of them does not necessarily mean that their license will be revoked or suspended. Loss of license/license revocation and not being able to operate a CMV because of being convicted of a disqualifying offense are two totally separate items. Besides reviewing each driver’s MVR to insure they haven’t been convicted of disqualifying offenses, management should also consider other, non-disqualifying, convictions present and determine and certify whether the driver meets company standards for mon mistakes seen in performing these processes include:MVRs which have acquisition dates which are vastly different from the driver’s certification of violations and/or the annual review of driver record;Certification of Violation forms and/or Annual Review forms which are not completed properly (missing signatures, dates, boxes not checked, etc);Section 2.3MVRs obtained/dated after Annual Review form is completed and dated;Failure to perform all three requirements (one, but not both, or no forms completed annually; no annual MVR obtained).The best practice to comply with these three regulations is to perform all three items at the same approximate time. The best process is:Acquire the driver’s MVR.Require the driver to fully complete the “Certification of Violations” form.A member of management should review the driver’s certification of violations, and then review the driver’s acquired MVR. Check any violations listed for disqualifying offenses and insure that driver meets company standards. Fully complete the “Annual Review of Driver Record” form.Once you have completed the three steps above, staple the items together and place in the DQF. If the above process if performed every 11 months for every driver, regardless of their hire date, you will consistently meet the annual (12) month requirement. If you choose do perform the above steps on an annual basis according to a drivers hire date, you’d better have a good record keeping practice and someone with the time to regularly study dates to meet the annual requirement. We strongly recommend the former practice.Evidence of performing these annual requirements must be retained in the DQF for three years. In other words, these items may be purged from the DQF three years after their date of execution.Included in Appendix B is a combined driver “Certification of Violations” and “Annual Review of Driver Record” form. Also included in Appendix B is a list of disqualifying offenses as listed in 391.15. The person who performs the annual review of driving record may wish to keep this form/list readily available to compare any violations listed on the MVR with disqualifying offenses.UPDATED MEDICAL EXAM/CERTIFICATE OF PHYSICAL EXAMINATIONSection 2.4&RENEWED DRIVER LICENSECertificate of Physical ExaminationAt least every two years (some may be more frequent depending on the results of the physical exam), your drivers will need to get another DOT medical exam and a new Certificate of Physical Examination to remain qualified to drive CMVs. As mentioned before, we strongly suggest that you have their physical examination performed by a company-designated licensed medical examiner who your company is confident is familiar with the DOT physical qualification criteria and the duties associated with their employment.At a minimum, the Certificate of Physical Examination (or a legible copy thereof) is required to be maintained in the DQF.Certificates of Physical Examinations (updates/renewals) must be maintained in the DQF for three years from the date of their execution. However, remember that the original Certificate of Physical Examination (obtained when the driver was hired) should be maintained indefinitely in the DQF.A copy of the Certificate of Physical Examination is included in Appendix A.Renewed Driver Licenses/CDLsWhile not technically required in the regulations, we suggest you always maintain a copy of each driver’s current CDL/license in the DQF. The driver’s license held at the time of hire should be maintained indefinitely in the DQF, along with the currently valid license held by the driver. Section 3.1SECTION THREETIPS ON SETTING UP THE DRIVER QUALIFICATION FILESetting up Driver Qualification Files in a consistent manner makes sense for when you need to access any paperwork contained inside. It also makes sense in terms of maintaining the file over time and making sure you know what you are purging if you do purge files as permitted. This section will provide advice on a simple way to set up the driver qualification file in a consistent manner.SETTING UP/CONSTRUCTING THE DRIVER QUALIFICATION FILESection 3.2There are many variations of Driver Qualification Files out there – from those which are strictly the DQF file, to those that double as the personnel file, training file, etc.Your best bet in setting up a DQF file is making sure that it contains only those materials that should reasonably be kept in the DQF, and not cluttered with other paperwork not relevant to the driver’s qualification – that’s what a personnel file is for. Keeping a simple and separate DQF will make it easier on you to track what is in the file and maintain the file properly, and also allow you to find and purge documents no longer required if you choose to do so.That being said, here is our suggestion for setting up and maintaining the DQF file:Equip a file folder so that, when opened, documents can be attached to either the left or right side of the file folder. Attach all “Original Documents” to the left side of the folder.Attach all “Recurring Documents” to the right side of the folder.Original Documents“Original Documents” are those documents submitted, obtained or executed during the hiring phase. All of these documents should be maintained indefinitely in the DQF. By attaching all of these documents on the left side of the file, they will be out of the way and never mistakenly purged - so long as it is understood that the left side of the DQF is designated as “untouchable”. All of the documents and items listed in SECTION ONE should be considered Original Documents.Listing of Original Documents:Employment ApplicationApplicant MVRCertificate of Physical ExaminationVerified Negative Pre-Employment Controlled Substance Test ResultRecord of Road Test & Certificate of Road Test (if given)Copy of Currently Valid, Properly Endorsed CDLLetter of Authorization & Rights Regarding Investigative InformationPrevious Employer Investigations & Inquiries Certificate of Compliance with Drivers License RequirementsDriver Statement of On-Duty Hours & Certification of Other Compensated WorkSection 3.3Recurring Documents“Recurring Documents” are those documents required to be obtained or executed on an annual basis and updates and renewals of original documents. These documents are obtained or executed after the driver has been employed. These recurring documents are also ones that may be purged at various times, in compliance with any retention requirements. All of the documents and items listed in SECTION TWO should be considered Recurring Documents.Listing of Recurring Documents:Annual MVRAnnual Certification of ViolationsAnnual Review of Driving RecordRenewals of Certificate of Physical ExamRenewals of CDLAPPENDIX AApplication for EmploymentDisqualifying OffensesCertificate of Physical ExaminationDriver’s Road Test Examination & Certificate of Driver’s Road TestLetter of Authorization & Rights Regarding Investigative InformationPrevious Employer/Safety Performance History Records RequestComplaint of Substantial ViolationCertificate of Compliance with Drivers License RequirementsDriver Statement of On-Duty Hours & Certification of Other Compensated WorkCompany NameStreet NameCity, State, Zip CodeApplication for EmploymentInstructions: Thank you for your interest in employment with the Company. Please complete all sections of this employment application to be considered for employment at the Company. We are an equal opportunity employer. Use additional paper if necessary to provide complete answers to any questions.Section 1: Personal InformationName:Date of Birth: / /LastFirstMiddleAddress:StreetCityStateZip CodeSocial Security Number:Telephone Number:( )Please list all addresses where you have resided in the past 3 years:Address:StreetCityStateZip CodeAddress:StreetCityStateZip CodeAddress:StreetCityStateZip CodeSection 2: Desired EmploymentDesired Position:Available Start Date: / /Compensation Desired:Have you ever applied for employment at this company before?Yes?No?Where:When:Have you ever worked for this company before?Yes?No?Where:When:Please list any other name under which you have been employed:Are you legally authorized to work in the United States on an unrestricted basis for any employer?Yes?No?Have you ever been convicted of a felony?Yes?No?If yes, please explain:Section 3: EducationEducation/TypeName and CityDid you Graduate?Degree ReceivedHigh SchoolYes?No?CollegeYes?No?Graduate SchoolYes?No?OtherYes?No?Section 4: Employment HistoryPlease provide your complete Employment History for the last 3 years. If you drove a commercial vehicle at any time in the 7 years before the last 3 years, please detail that employment information also. Ask for/use extra paper if necessary.Name of Present or Last Employer:Address:StreetCityStateZip CodeStarting Date (M/Y): / Date Last Worked (M/Y): /Job Title:Starting Salary/Hourly Rate:Final Salary/Hourly Rate:Starting Commission/Bonus:Final Commission/Bonus:Summarize Type of Work Performed and Job Responsibilities:Reason(s) for Leaving:If you were terminated or asked to resign, please explain:May we contact your supervisor?Yes?No?If no, why?Supervisor’s Name:Title:Employer’s Phone #:( )Were you subject to Federal Motor Carrier Safety Regulations (DOT Regulations) while employed?Yes?No?Was your job designated as safety sensitive function in any DOT Regulated mode? Were you subject to DOT-Required Drug and Alcohol Testing?Yes?No?Section 4: Employment History ContinuedName of Present or Last Employer:Address:StreetCityStateZip CodeStarting Date (M/Y): / Date Last Worked (M/Y): /Job Title:Starting Salary/Hourly Rate:Final Salary/Hourly Rate:Starting Commission/Bonus:Final Commission/Bonus:Summarize Type of Work Performed and Job Responsibilities:Reason(s) for Leaving:If you were terminated or asked to resign, please explain:May we contact your supervisor?Yes?No?If no, why?Supervisor’s Name:Title:Employer’s Phone #:( )Were you subject to Federal Motor Carrier Safety Regulations (DOT Regulations) while employed?Yes?No?Was your job designated as safety sensitive function in any DOT Regulated mode? Were you subject to DOT-Required Drug and Alcohol Testing?Yes?No?Name of Present or Last Employer:Address:StreetCityStateZip CodeStarting Date (M/Y): / Date Last Worked (M/Y): /Job Title:Starting Salary/Hourly Rate:Final Salary/Hourly Rate:Starting Commission/Bonus:Final Commission/Bonus:Summarize Type of Work Performed and Job Responsibilities:Reason(s) for Leaving:If you were terminated or asked to resign, please explain:May we contact your supervisor?Yes?No?If no, why?Supervisor’s Name:Title:Employer’s Phone #:( )Were you subject to Federal Motor Carrier Safety Regulations (DOT Regulations) while employed?Yes?No?Was your job designated as safety sensitive function in any DOT Regulated mode? Were you subject to DOT-Required Drug and Alcohol Testing?Yes?No?Section 4: Employment History ContinuedName of Present or Last Employer:Address:StreetCityStateZip CodeStarting Date (M/Y): / Date Last Worked (M/Y): /Job Title:Starting Salary/Hourly Rate:Final Salary/Hourly Rate:Starting Commission/Bonus:Final Commission/Bonus:Summarize Type of Work Performed and Job Responsibilities:Reason(s) for Leaving:If you were terminated or asked to resign, please explain:May we contact your supervisor?Yes?No?If no, why?Supervisor’s Name:Title:Employer’s Phone #:( )Were you subject to Federal Motor Carrier Safety Regulations (DOT Regulations) while employed?Yes?No?Was your job designated as safety sensitive function in any DOT Regulated mode? Were you subject to DOT-Required Drug and Alcohol Testing?Yes?No?Name of Present or Last Employer:Address:StreetCityStateZip CodeStarting Date (M/Y): / Date Last Worked (M/Y): /Job Title:Starting Salary/Hourly Rate:Final Salary/Hourly Rate:Starting Commission/Bonus:Final Commission/Bonus:Summarize Type of Work Performed and Job Responsibilities:Reason(s) for Leaving:If you were terminated or asked to resign, please explain:May we contact your supervisor?Yes?No?If no, why?Supervisor’s Name:Title:Employer’s Phone #:( )Were you subject to Federal Motor Carrier Safety Regulations (DOT Regulations) while employed?Yes?No?Was your job designated as safety sensitive function in any DOT Regulated mode? Were you subject to DOT-Required Drug and Alcohol Testing?Yes?No?Section 4: Employment History ContinuedName of Present or Last Employer:Address:StreetCityStateZip CodeStarting Date (M/Y): / Date Last Worked (M/Y): /Job Title:Starting Salary/Hourly Rate:Final Salary/Hourly Rate:Starting Commission/Bonus:Final Commission/Bonus:Summarize Type of Work Performed and Job Responsibilities:Reason(s) for Leaving:If you were terminated or asked to resign, please explain:May we contact your supervisor?Yes?No?If no, why?Supervisor’s Name:Title:Employer’s Phone #:( )Were you subject to Federal Motor Carrier Safety Regulations (DOT Regulations) while employed?Yes?No?Was your job designated as safety sensitive function in any DOT Regulated mode? Were you subject to DOT-Required Drug and Alcohol Testing?Yes?No?Employment Gaps: Explain any periods that you were not working during the last 10 years other than due to personal illness, injury or disability.Related Information: If you hold any certifications, are a member of any job related organizations (professional, trade, etc.) or have received any job-related awards or accomplishments, list and describe them.Job Skills and Qualifications: Summarize any special training skills, licenses and/or certificates that may assist you in performing the position for which you are applying. If driving is required in the job for which you are applying, please provide your valid driver’s license number, expiration date, and state of issuance.Section 5: Driver InformationDriver’s license information: Please list all States in last 3 years where a license was held.StateLicense NumberType (Class)Expiration DateDriver’s LicensesDriving experience: Please list all driving experience.Class of EquipmentType of Equipment(Flatbed, Van, Mini-Bus etc.)DatesApproximate Number of Miles (Total)FromToBusTractor andSemi-TrailerOther (Indicate Type)Accident record for the past 3 years or more (Attach sheet if more space is needed)DateNature of Accident(Head-on, Rear-end, Upset, etc.)Fatalities?Injuries?Last AccidentNext PreviousNext PreviousNext PreviousTraffic Convictions and Forfeitures for the past 3 years (Other than parking violations)LocationDateChargeType of Vehicle OperationsSection 5: Driver Information ContinuedIf the answer to any of the questions below is Yes, please attach a statement giving details.1.Have you ever been denied a license, permit or privilege to operate a motor vehicle?Yes?No?If you answer “yes”, you much attach a statement giving details.2.Have any license, permit or driving privilege ever been suspended or revoked?Yes?No?3.For the past 2 years, have you tested positive or refused to test on any pre-employment drug or alcohol test required by a DOT-regulated employer because you would perform safety-sensitive transportation work?Yes?No?If you answered “yes”, you must identify the DOT-regulated employers and when the testing took place in the space below. You must provide the Company with documentation that you successfully completed the return-to-duty process required by the DOT regulations. Failure to provide this documentation to the Company within two (2) weeks or other time period determined by the Company will result in the withdrawal of any job offer/transfer.Section 6: Acknowledgement, Certification, AuthorizationI, the applicant, certify that the entries and information set forth in this Application are true and complete to the best of my knowledge. I understand that deliberately entering false information will result in the withdrawal of any offer/transfer.Applicant SignatureDateSection 6: Acknowledgement, Certification, Authorization ContinuedPLEASE READ CAREFULLY BEFORE SIGNING. Initial this page where indicated and sign the next page after reading all certifications and notices contained therein.1.I certify that the information contained in this application for employment at the Company is correct and complete. I understand that any false or misleading statements or omissions made in this application or interview(s), whenever discovered are grounds for disqualification from further consideration or for dismissal from employment, regardless of how discovered.2.I understand that if I am offered employment at the Company it is at-will and can be terminated at any time and for any reason with or without advance notice by myself or the company.3.I understand and agree that only the Company has any authority to enter into any agreement to employ me for any specified period of time or to modify terms and conditions of my employment. I agree that such an agreement must be in writing and signed by the President, and I will not rely upon any other representations regardless of the source.4.I understand and agree that the Company may make a full complete investigation of my personal employment history, and authorize any former employer, person, firm, corporation, school, government agency, or other entity to provide the Company with any information (including fact or opinion) they may have regarding me. In consideration of the Company’s review of this application, I release the Company and all providers of any information from any liability, which may arise as a result of furnishing or receiving this information. I understand and agree any employment offer or continued employment shall authorize the Company to provide truthful information (fact or opinion) regarding my employment to any potential or future employer and release and waive any claims against the company for truthfully communicating any such information to be potential or future employer.5.I understand and agree that I may be required to submit to drug testing and complete a medical examination as part of my application for employment. I also understand and agree that I may be required to submit to a complete medical examination during my employment with the Company, provided that such examination is job-related and consistent with business necessity. I authorize the physician conducting the examination and any laboratory testing, any specimen obtained by the physician or collection site to disclose the results of the examination and the laboratory test to the Company in accordance with state and/or federal laws. The Company will keep such results confidential and disclose the results only to persons who need to know where required by law. Also, I agree to fully cooperate and provide the company with any additional consent(s) and/or release(s) as required by the Company to investigate my employment application. 6.I agree that the Company may investigate and consider any criminal conviction record that I may have after it makes a conditional offer of employment. The Company may withdraw a conditional employment offer if I have a criminal conviction record which bears a rational relationship to the duties and responsibilities of the position for which I am applying. 7.I understand and agree that if offered employment by the Company I may be required to disclose military service information in accordance with law, and that any such employment offer shall be depended upon the receipt of satisfactory military record as determined by the Company.8.If hired, I agree not to disclose or use confidential information belonging to prior employees and that I will inform the Company of any agreements that would limit my ability to work for the Company.Initial HereSection 6: Acknowledgement, Certification, Authorization ContinuedDisclosure and Authorization to Obtain Consumer Reports and Driving Performance HistoryIn order to evaluate you for hiring, promotion, reassignment, transfer, retention in employment, or other employment-related purposes, the Company may decide to obtain a consumer report bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. However, no consumer report will be obtained by the Company for employment purposes without your prior written authorization. I hereby acknowledge that the Company has disclosed, in writing, that it may obtain a consumer report bearing on my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living for employment purposes. I hereby authorize the Company and its representatives and agents to obtain a consumer report bearing on my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living.I hereby acknowledge and consent to the Company to obtain and review reports of driver history from states in which a license has been held in accordance with, but not limited to, 48 CFR Part 391. This consent shall be considered continuing, permitting for additional driver history inquiries as deemed necessary by the Company for the entire length of my employment with the Company.Previous Employer Inquiries and InvestigationsAs required by 391.23, we will make investigative inquiries to previous DOT-regulated employers related to your employment history, drug and alcohol testing results, and accident history. We will use this information in our hiring decision. Pursuant to 391.23, you have the following rights with regard to responses received in these areas from previous DOT-regulated employers:1.The right to review information provided by previous DOT-regulated employers:2.The right to have errors in the information corrected by the previous employer; and for that previous employer to re-send the corrected information to the prospective employer;3.The right to have a rebuttal statement attached to the alleged erroneous information, if you and the previous employer cannot agree on the accuracy of the information.If you wish to review previous DOT-regulated employer information received in response to required inquiries, you must submit a written request to the prospective employer no later than 30 days after being employed or being notified of denial of employment. After making such written request, any information received will be provided to you within five days, unless no such information has been provided in response to required inquiries. For information on procedures to rebut information provided by previous DOT-regulated employers, see Title 49 of the Coded Federal Regulations (CFR), Part 391.23(j). I hereby acknowledge and certify that I have read and understood these Authorizations and Notifications on this and the previous page (pages 7 & 9) of this Application for Employment.Authorization SignatureDatePrint NameDISQUALIFYING OFFENSESEvery time a driver MVR is received, it should be reviewed to insure that:The operator’s license is still valid (has not been suspended or revoked)The operator has not been convicted of a disqualifying offense as listed in the FMCSRs, 391.15.If a driver is determined to be disqualified, the carrier may not permit him to operate a CMV.The following are disqualifying events:Suspension, revocation or denial of operating privilegesDriving a commercial motor vehicle while under the influence of alcohol. This shall include:Driving a commercial motor vehicle while the person's alcohol concentration is 0.04% or more;Driving under the influence of alcohol, as prescribed by State law; orRefusal to undergo such testing as is required by any State or jurisdiction in the enforcement of driving under the influence of alcoholDriving a commercial motor vehicle under the influence of an identified controlled substance, an amphetamine, a narcotic drug, a formulation of an amphetamine or a derivative of a narcotic drug;Transportation, possession, or unlawful use of an identified controlled substance, amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs while the driver is on duty;Leaving the scene of an accident while operating a commercial motor vehicle; orCommitting a felony involving the use of a commercial motor vehicle.CERTIFICATE OF PHYSICAL EXAMINATIONDRIVER’S ROAD TEST EXAMINATIONDriver’s Name:Phone Number:( )LastFirstMiddleDriver’s Address:StreetCityState Zip CodeThe 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 PerformanceThe pre-trip inspection. (As required by section 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 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 test:Date: / /Examiner’s Signature:If the road test was successfully completed, the person who gave it shall complete a certificate of driver’s road test.Remarks:This form should be maintained indefinitely in the Driver’s Qualification FilesCERTIFICATE OF DRIVER’S ROAD TESTInstructions: If the road test is successfully completed, the person who gave it shall complete a certificate of the driver’s road test. The original copy of the certificate shall be retained in the employing motor carrier’s driver qualification file of the person examined and a copy given to the person who was examined. (49 CFR 391.31(e)(f)(g))CERTIFICATE OF ROAD TESTDriver’s Name:Social Security Number:Operator’s or Chauffeur’s License Number:State:Type of Power Unit:Type of Trailer(s):If Passenger Carrier, Type of Bus:This is to certify that the above-named driver was given a road test under my supervision on,,20 , consisting ofapproximatelymiles of driving.It is my considered opinion that this driver possesses sufficient driving skill to operate safely the type of commercial motor vehicle listed above.(Signature of Examiner)(Title)(Organization and Address of Examiner)This form should be maintained indefinitely in the Driver Qualification File.LETTER OF AUTHORIZATIONAND RIGHTS REGARDING INVESTIGATIVE INFORMATIONTo Whom it May Concern,I hereby authorizeor its agents, to verify information provided by my inconnection with my application and interview, including information regarding past drug and alcohol test results, as may be necessary or required at the company’s discretion. I authorize all persons who may have information relevant to these inquiries to disclose it to the above-identified company or its agents. I release persons from any liability on the account of such disclosure.Name:Last NameFirst NameMiddle NameDate of Birth: / /Signature:Date: / /Applicants with Previous DOT-Regulated Employment -Rights Regarding Investigative InformationAs required by 391.23, we will make investigative inquiries to previous DOT-regulated employers related to your employment history, drug and alcohol testing results, and accident history. We will use this information in our hiring decision.Pursuant to 391.23, you have the following rights with regard to responses received in these areas from previous DOT-regulated employers:The right to review information provided by previous DOT-regulated employers:The right to have errors in the information corrected by the previous employer; and for that previous employer to re-send the corrected information to the prospective employer;The right to have a rebuttal statement attached to the alleged erroneous information, if you and the previous employer cannot agree on the accuracy of the information.If you wish to review previous DOT-regulated employer information received in response to required inquiries, you must submit a written request to the prospective employer no later than 30 days after being employed or being notified of denial of employment. After making such written request, any information received will be provided to you within five days, unless no such information has been provided in response to required inquiries. For information on procedures to rebut information provided by previous DOT-regulated employers, see Title 49 of the Coded Federal Regulations (CFR), Part 391.23(j). This form should be maintained indefinitely in the Driver Qualification File.ATTENTION: Human Resources/Personnel Department(Prospective Employer: Company Name)is federally regulated by the US Department of Transportation (USDOT) and the FederalMotor Carrier Safety Administration (FMCSA). As such, we are required by law to contact previous/current employers where an applicant has operated commercial vehicles to obtain specific information. This form includes information we are required to obtain under 49 CFR Part 391.23.As a previous/current employer of a commercial vehicle operator, you are required by law to comply with this request and provide information as indicated under 49 CFR Part 391.23(g). Below is an executed release authorization from your previous/current employee (Section 1). On the following page are inquiries, which must be completed (Section 2).Thank you for your cooperation. Information can be returned confidentially via any of the following methods:1.Via Fax to:2.Via Email to:3.Via US Mail to:INSTRUCTIONS TO COMPLETE THIS FORMSECTION 1: Prospective Employee/ApplicantComplete the information required in this sectionSign and dateSubmit to the Prospective EmployerSection 1TO BE COMPLETED BY PROSPECTIVE EMPLOYEE/APPLICANTI, (Print Name)FirstMiddleLastSocial Security Numberhereby authorize:/ /Date of BirthPrevious Employer:Address:StreetCityStateZip CodeEmail:Telephone #:( )Fax #:( )to release and forward the information requested by Section 2 of this document concerning my employment records for the previous 3 years to:Prospective Employer:/ /Applicant’s SignatureDateSECTION 2: Previous EmployerComplete the information in this section; sign, date and return to the Prospective Employer.Section 2TO BE COMPLETED BY PREVIOUS EMPLOYERACCIDENT HISTORYThe applicant named in Section 1 above was employed by us.Yes?No?Employed asFrom (M/Y)/To (M/Y)/Did he/she drive a motor vehicle for you?Yes?No?If yes, what type of vehicle?Why did he/she leave your Company?Quit?Terminated?Laid Off?Would you re-hire?Yes?No?ACCIDENTS:Complete the following for any accidents included on your DOT Accident Register (§390.15(b)) that involved the applicant in the 3 years prior to the application date shown above, or check here ? if there is no accident register data for this driver.DateLocationNumber of InjuriesNumber of Fatalities1./ /2./ /3./ /Please provide information concerning any other accidents involving the applicant that were reported to government agencies or insurers under internal company policies:DRUG AND ALCOHOL HISTORYIf the driver was not subject to US DOT testing requirements while employed by you, please check here ? sign, and return.Driver was subject to US DOT testing requirements from to.YESNO1.Has this person had an alcohol test with a result of 0.04 or higher alcohol concentrate???2.Has this person tested positive or adulterated or substituted a test specimen for controlled substances???3.Has this person refused to submit to a post-accident, random, reasonable suspicion, or follow-up alcohol or controlled substance test???4.Has this person committed other violations of Subpart B of Part 382, or Part 40???5.If this person has violated a DOT drug and alcohol regulation, did this person fail to undertake or complete a program prescribed by a Substance Abuse Professional (SAP) in your employ? If no, please send documentation back with this form. If you are unsure, check yes.??6.For a driver who successfully completed SAP’s rehabilitation referral and remained in your employ, did this driver subsequently have an alcohol test result of 0.04 or greater, a verified positive drug test, or refused to be tested???In answering these questions, include any required DOT drug or alcohol testing information obtained from prior previous employers in the previous 3 years prior to the application date shown in Section 1.Name:Telephone #:( )Company:Address:StreetCityStateZip CodeSection 2 complete by:SignatureDateCOMPLAINT OF SUBSTANTIAL VIOLATIONFiled in Accordance with 49 CFR 386.12Per 49 CFR 391.23(c)(3), the undersigned is reporting the failure of a previous DOT-regulated employer to respond as required to necessary and required investigations and inquiries relating to a previous employee.The following motor carrier failed to respond as required to previous employee inquiries posed as required under 40 CFR 391.23(a)(2), 391.23(d), and 391.23(e). In failing to reply as required, the named motor carrier has violated 49 CFR 391.23(g).Name of Carrier:_______________________Address of Carrier:____________________________Respectfully Yours,NAMETITLECOMPANY NAMEADDRESSPHONE NUMBERCERTIFICATION OF COMPLIANCEWITH DRIVERS LICENSE REQUIREMENTSDRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1, 1987. They are as follows:POSSESS ONLY ONE LICENSE: You as a commercial vehicle driver, may not possess more than one vehicle operator’s license.If you have more than one license, keep the license from your state of residence and return the additional licenses to the state that issued them. Destroying a license does not close the record in the state that issued it; you must notify the state. If a multiple license has been lost, stolen or destroyed, close your record by notifying the state of issuance that you no longer want to be licensed by that state.NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION: Sections 392.42 and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation or suspension of your drivers license. In addition, Section 383.31 requires that any time you violate a state or local traffic law (other that parking), you must report it in 30 days to: (1) your employing motor carrier, and (2) the state that issued your license (if the violation occurs in a state other than the one which issued your license). The notification to both the employer and state must be in writing.The following license is the only one I will possess:Driver’s License Number:State:Exp. Date:/ /DRIVER CERTIFICATION: I certify that I have read and understood the above requirements.Driver’s Name (Printed):Driver’s Signature:Date:/ /Notes:This form should be maintained indefinitely in the Driver Qualification File.DRIVER STATEMENT OF ON-DUTY HOURS(For Newly Hired, Intermittent, Casual or Occasional Drivers)INSTRUCTIONS: Motor carriers when using a driver for the first time or intermittently shall obtain from the driver a signed statement giving the driver’s 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 (see section 395.8(j)(2) Federal Motor Carrier 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. COMPLETE ENTIRE FORM.Driver’s Name (Print):Drivers License Number:Social Security Number:Type of License:Issuing State:Day1234567(yesterday)DateTotal HoursHoursWorkedI hereby certify that the information given is correct to the best of my knowledge and belief, and that I was last relieved from work at…A.M.P.M.OnTimeDayMonthYearDrivers SignatureDateDRIVER CERTIFICATION FOR OTHER COMPENSATED WORKINSTRUCTIONS: 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 non-motor carrier entity.Are you currently working for another employer? Yes NoAt this time do you intend to work for another employer while still employed by this company? Yes NoI hereby certify that the information given 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.Employee SignatureDateCompany RepresentativeThis form should be maintained indefinitely in the Driver Qualification File.APPENDIX BCombined ‘Certification of Violations’ & ‘Annual Review of Driving Record’ FormDisqualifying OffenseMOTOR VEHICLE DRIVER’SCERTIFICATION OF VIOLATIONS/ANNUAL REVIEW OF DRIVING RECORDMOTOR 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 carrier traffic laws and ordinances (other than violations involving 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 as stated in section 391.27 of the Federal Motor Carrier Safety Regulations. Drivers who have provided information required by section 383.31 of the Regulations need not repeat the information on this form.DRIVER REQUIREMENTS: Each driver shall furnish the list as required by 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 as stated in section 391.27 of the Federal PLETED BY DRIVER – CERTIFICATION OF VIOLATIONSName of Driver (Print)Social Security NumberDate of Employment (if known)Home Terminal (City and State)Driver’s License Number and StateDriver’s License Expiration DateI 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 no violations, check the following box:?NoneDATEOFFENSELOCATIONTYPE OF VEHICLE OPERATEDIf 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 listed under Part 383) required to be listed during the past 12 months.Date of Certification:/ /Driver’s Signature:COMPLETED BY MOTOR CARRIER – ANNUAL REVIEW OF DRIVING RECORDMOTOR 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 requested form 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 the minimum requirements for safe driving?Is qualified to drive a motor vehicle pursuant to Section 391.15?Does not adequately meet satisfactory safe driving performanceAction taken with driver:Reviewed by:/ /SignatureDatePrinted NameTitleMotor Carrier NameMotor Carrier AddressTo be place in the driver qualification file. This document may be purged after 3 years from the date of execution.DISQUALIFYING OFFENSESEvery time a driver MVR is received, it should be reviewed to insure that:The operator’s license is still valid (has not been suspended or revoked)The operator has not been convicted of a disqualifying offense as listed in the FMCSRs, 391.15.If a driver is determined to be disqualified, the carrier may not permit him to operate a CMV.The following are disqualifying events:Suspension, revocation or denial of operating privilegesDriving a commercial motor vehicle while under the influence of alcohol. This shall include:Driving a commercial motor vehicle while the person's alcohol concentration is 0.04% or more;Driving under the influence of alcohol, as prescribed by State law; orRefusal to undergo such testing as is required by any State or jurisdiction in the enforcement of driving under the influence of alcohol3.Driving a commercial motor vehicle under the influence of an identified controlled substance, an amphetamine, a narcotic drug, a formulation of an amphetamine or a derivative of a narcotic drug;4.Transportation, possession, or unlawful use of an identified controlled substance, amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs while the driver is on duty;5.Leaving the scene of an accident while operating a commercial motor vehicle; mitting a felony involving the use of a commercial motor vehicle.APPENDIX CQualifying a Driver/New Driver Qualification File ChecklistDriver Qualification File – Recurring Maintenance ListDRIVER QUALIFICATION FILE CHECKLISTOriginal Documents/Time of Hire – Maintain in Driver Qualification File indefinitely unless otherwise noted____Employment Application____Applicant MVR (and annual MVRs thereafter)____Valid Medical Examiner’s Certificate (including notation/documentation verifying the listed medical examiner is certified in the National Registry of Certified Medical Examiners) ____Verified Negative Pre-employment Controlled Substance result____Road Test form and Certificate of Road Test (if given – not required if have copy of valid CDL w/proper endorsements for equipment operating); ____Copy of currently valid CDL ____Previous Employer Safety Performance History Requests (sent to each employer where applicant drove a CMV within past three years)____Certificate of Compliance with Driver License Requirements____Driver Statement of On-Duty Hours for 7 days (prior to first use as driver – may be discarded after 6 months) ____Certification of Outside Employment____Waivers for Physical Disqualification (if applicable)Other forms not required in DQF, but suggested____Signed receipt of drug and alcohol policy____Signed receipt of Federal Motor Carrier Safety Regulation book____Signed receipt of company policy handbookDRIVER QUALIFICATION FILERECURRING MAINTENANCE LISTDocuments must be retained for three years from date of execution.YEAR:Annual “Certification of Violations” listing/form (driver)Date:/ /Annual MVR obtainedDate:/ /“Annual Review of Driver Record” form (management)MVR reviewed for ‘Disqualifying Offense’ convictions??YesMVR compared against violations listed on the “Annual ?YesCertification of violations” form?License currently valid and all required endorsements valid??YesDate:/ /Copy of currently valid CDL with proper endorsementsDate of Expiration:/ /Copy of currently valid Medical Examiner CertificateDate of Expiration:/ / ................
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