The Driver Qualification form is a crucial document used by employers to assess the qualifications of commercial drivers. It includes various components, such as employment history, driving records, and medical certifications, ensuring that drivers meet necessary safety standards. To facilitate the hiring process, it is essential for potential drivers to complete this form accurately; click the button below to fill it out.
The Driver Qualification form serves as a vital tool in ensuring that commercial drivers meet the necessary standards for safety and compliance. This comprehensive document includes several key components that reflect a driver's qualifications and history. First, it requires the completion of a Driver Application for Employment, which gathers essential personal information and work history. Employers must conduct inquiries into previous employers and state agencies to verify the driver's past performance and compliance with regulations. A Medical Examiner’s Certificate is also required, confirming that the driver meets health standards, along with documentation of a Driver’s Road Test to assess driving skills. Additionally, drivers must provide an Annual Driver’s Certificate of Violations and undergo an Annual Review of their driving record. This form is not just a checklist; it is a thorough assessment that contributes to a safer driving environment for everyone on the road. By ensuring that each driver meets these criteria, companies can maintain high safety standards while fostering a culture of accountability and responsibility within their teams.
DRIVER QUALIFICATION FILE
CHECKLIST
1.
DRIVER APPLICATION FOR EMPLOYMENT
391.21
2.
INQUIRY TO PREVIOUS EMPLOYERS (3 YEARS)
391.23(a)(2) & (c)
3.
INQUIRY TO STATE AGENCIES
391.23(a)(1) & (b)
4.
MEDICAL EXAMINER’S CERTIFICATE*
391.43
(MEDICAL WAIVER, IF ISSUED)
5.
DRIVER’S ROAD TEST
391.31
6.
CERTIFICATION OF ROAD TEST*
7.
ANNUAL DRIVER’S CERTIFICATE OF VIOLATIONS
391.27
8.
ANNUAL REVIEW OF DRIVING RECORD
391.25
9.
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.
1
(enter company name)
(enter address)
__________________
(enter phone number)
COMMERCIAL DRIVER APPLICATION
FILL IN ALL BLANKS & PROVIDE ALL INFORMATION REQUESTED--PRINT OR TYPE
…………………………………………………………………………………………………………………………………….
Date: _______________________
Name:
First_____________________ Middle_________________ Last______________________________________
Address _________________________________________________
Home telephone: _____________________
City_______________________ State _______ Zip ___________
Cellular telephone: _____________________
Date of Birth: ____________________________
Social Security Number: _______ - _______ - __________
If your above address is less than 3 years continue listing them below to cover the previous 3 year period:
Street_________________________________________________
Dates: From_________ To_________
……………………………………………………………………………………………………………………………….
2 Street_________________________________________________ Dates: From_________ To_________
3
Use backside of sheet for additional addresses
Driver’s License Information: all licenses held, last 3 years:
State_______________ Number___________________________________________ Expiration Date _______________
Experience:
__________________________________
________________ to ________________
____________________________
Type of vehicle driven
Dates
Approximate mileage driven
All Accidents, last 3 years: (If none, write NONE)
Date________________ Describe_______________________________ Fatalities_____________ Injuries_____________
July2003,dlnm2
revised 08/04
List all Traffic Violations Convictions, last 3 years: (If none, write NONE)
Date______________ Violation____________________________________ State_______ Commercial Vehicle: Yes / No
Have you ever had any driver license denied, suspended, revoked or canceled by any issuing state agency?
Yes
No
If yes; state of issuance; explanation: ___________________________________________________
____________________________________________________________________________________________________
Employment History, last 10 years (383.35)—account for gaps between employers: (If owner/operator, list carriers leased to)
1)
Employer:_____________________________________________
Dates: ________________to________________
Address: _____________________________________________
Supervisor: ______________________________
City, State, Zip code:____________________________________
Telephone: ______________________________
Were you subject to the Federal Motor Carrier Safety Regulations during this period?
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?
Reason for Leaving: __________________________________________________________________________________
………………………………………………………………….……………………….………………………………………...
2)
Address: ___________________________________________ Supervisor:________________________________
City, State, Zip code: ____________________________________
July2003,dlnm
3)Employer:_____________________________________________ Dates: ________________to________________
Address: _____________________________________________ Supervisor: ______________________________
City, State, Zip code: _____________________________________Telephone: ______________________________
4)Employer:_____________________________________________ Dates: ________________to________________
Address: _____________________________________________ Supervisor:________________________________
City, State, Zip code______________________________________ Telephone: ______________________________
5)Employer:_____________________________________________ Dates: ________________to________________
City, State, Zip code:_____________________________________ Telephone: ______________________________
6) Employer:_____________________________________________ Dates: ________________to________________
City, State, Zip Code:_____________________________________Telephone: ______________________________
4
7) Employer:_____________________________________________ Dates: ________________to________________
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 -send the corrected information to the prospective employer; the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.
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.”
___________________________________________________________
Applicant’s Signature
Date Signed
TO BE COMPLETED BY THE EMPLOYER:
Application received by:
Application reviewed for completeness by:
______________________________________________
Name
_________________________
_______________
__________________________
Title
Date
SIGNIFICANT DATES:
Date of Hire:
_____________________________________
Time & Date of Pre-Employment CST:
Time & Date of Pre-Employment CST Results Received:
Date First Used in Safety Sensitive Position:
Date of Termination:
5
___________________________
COMMERCIAL VEHICLE DRIVER APPLICANT
Controlled Substance and Alcohol Questionnaire
Pursuant to 49 CFR part 40.25(j)
Application Date _______________________
Name ______________________
_______________________
______________________________________
First
Middle
Last
Home Telephone
_____________________
Cell Telephone
Date of Birth
Social Security Number ________ - ________ - ________
49 CFR 40.25(j)
Have you ever tested positive, or refused to test, on any pre -employment
drug or alcohol test administered by an employer to which you applied
YES
NO
for, but did not obtain, safety-sensitive transportation work covered by
DOT agency drug and alcohol testing rules during the past two years?
If YES —
Have you successfully completed the return-to-duty
process?
Documentation MUST BE PROVIDED before any
safety-sensitive
transportation function is performed.
TO BE COMPLETED BY EMPLOYER:
Received by:
Reviewed by:
____________________
Title:
Date:
6
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 651-291-6150, during business hours.
TO:
(enter former employer's name)
________________________________________________ DATE: _________________
Former Employer’s Name
(enter mailing address)
Mailing Address
(enter city / state / zip)
City / State / Zip
(enter fax number)
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
_______________________________
___________________
Witness’s Signature & Date
REQUEST FROM:
Company:
_______________________________________________________
Address/City/State/Zip:
Telephone Number:
(enter phone number) Fax Number: (enter fax number)
Contact Person & Title
_________________________________
NAME OF APPLICANT:
_________________________________ SSN _________________
JOB APPLYING FOR:
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 re-employ this person? YES or NO IF NO, please explain:
•Additional comments:
INQUIRY FOR ALCOHOL AND CONTROLLED SUBSTANCES INFORMATION, PRECEDING 2 YEARS
•
Alcohol tests with a result of 0.04 or greater? ……….
YES or NO
If yes, please give date(s): ________________
• Verified positive controlled substances test results? …
• Refusals to be tested? …………………………………
Was rehabilitation completed as required? …………...
Person providing the above information:
Name: ________________________________________________ Title: ______________________________
Company: ________________________________________________ Date: ______________________________
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 applicant-driver has held a motor vehicle operator's license or permit during those 3 years.
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
Motor Carrier Name
Street
City
State
Zip
revised
08/04
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MEDICAL EXAMINER’S CERTIFICATE
I certify that I have examined ______________________________ in accordance with the Federal Motor Carrier Safety
Regulations (49 CFR 391.41-391.49) and with knowledge of the driving rules, I find this person is qualified, and, if applicable,
only when:
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
Telephone
Medical Examiner’s Name (Print)
MD
DO
Chiropractor
Physician
Advanced
Assistant
Practice Nurse
Medical Examiner’s License or Certificate No. / Issuing State
Signature of Driver
Driver’s License No.
PLE
M
Address of Driver
Medical Certificate Expiration Date
SA
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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
The pre-trip inspection (as required by 49 CFR 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’s 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 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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Filling out the Driver Qualification form is an important step in the hiring process for commercial drivers. After completing the form, it will be reviewed by the employer to ensure all necessary information is provided. Following the review, the employer will take further steps to verify the information and proceed with the hiring process.
The Driver Qualification form is a document that collects essential information about a driver's background, experience, and qualifications. It is used by employers to ensure that drivers meet the necessary standards for safety and compliance in the transportation industry.
You will need to fill out various details, including:
Your employment history is crucial as it helps employers assess your experience and reliability as a driver. It also ensures that you have been subject to the Federal Motor Carrier Safety Regulations during your previous employment.
If you have gaps in your employment history, it is important to account for them. You can provide explanations for these gaps, which can help clarify your situation to potential employers.
If you have traffic violations, you must list them on the form. Be honest and provide all necessary details, including the date and nature of the violation. This transparency is vital for your application.
You have the right to review information provided by previous employers about your driving record. If you find any errors, you can request corrections. You may also attach a rebuttal statement if there is a disagreement over the accuracy of the information.
After you submit the form, the employer will review it for completeness. If everything is in order, they will proceed with the hiring process, which may include background checks and other evaluations. You will also be informed about the next steps regarding your application.
Filling out the Driver Qualification form is a crucial step for anyone seeking employment as a commercial driver. However, many applicants make common mistakes that can delay the hiring process or lead to disqualification. Understanding these pitfalls can help ensure a smoother application experience.
One frequent error is failing to complete all required fields. Applicants often overlook sections, especially when they believe certain information is not applicable. Every blank must be filled out, even if it means writing "N/A" for questions that do not apply. Incomplete applications may be rejected outright.
Another common mistake involves providing inaccurate information. This can include misspellings of names, incorrect dates, or wrong addresses. Accuracy is essential, as discrepancies can raise red flags for potential employers. Always double-check the information before submitting the form.
Many applicants also neglect to list all previous employers for the required time frame. The form requests a comprehensive history of employment over the last ten years. Failing to account for gaps or not listing all employers can lead to questions about the applicant's work history.
Additionally, some applicants forget to disclose traffic violations or accidents. Even minor infractions should be reported. Omitting this information can be perceived as dishonesty, which can jeopardize the applicant's chances of employment.
Another mistake is not providing correct contact information for previous employers. This can hinder the verification process. Ensure that all phone numbers and addresses are accurate and up-to-date to facilitate timely communication.
Some individuals also fail to include their medical examiner’s certificate or do not have it readily available while driving. This document is critical for compliance with federal regulations. It is essential to keep a copy on hand and submit it as required.
Applicants sometimes forget to sign and date the application, which is a simple yet vital step. An unsigned application cannot be processed. Always ensure that the certification statement is completed, as it confirms the truthfulness of the provided information.
Finally, a lack of attention to detail can lead to various small errors that accumulate. Taking the time to review the entire application thoroughly can prevent many issues. A careful approach can make a significant difference in the outcome of the application.
By being mindful of these common mistakes, applicants can improve their chances of a successful hiring process. Attention to detail and accuracy are key components of a strong application. With careful preparation, the path to becoming a commercial driver can be much smoother.
When hiring drivers, several key documents complement the Driver Qualification form. Each of these documents plays a vital role in ensuring that the driver meets the necessary qualifications and complies with regulatory requirements. Below is a list of commonly used forms and documents.
These documents collectively ensure that a thorough vetting process occurs before a driver is hired. They help maintain safety standards within the industry and protect both the employer and the public.
When filling out the Driver Qualification form, attention to detail is crucial. Below is a list of things to do and avoid to ensure a complete and accurate submission.
This form is required for all drivers, including those transferring from other companies or those returning to driving after a break. It ensures that all drivers meet the necessary qualifications, regardless of their employment history.
In fact, a medical examiner’s certificate is mandatory for all drivers operating commercial vehicles. This certificate confirms that the driver meets the health standards required by the Department of Transportation.
Employers must inquire about a driver's previous employment history for the past three years. This step is crucial to ensure that the driver has a safe driving record and complies with regulations.
All traffic violations must be disclosed on the form, even if they seem minor. Transparency is key to maintaining safety standards in the industry.
All accidents, regardless of severity, should be reported. This includes accidents with injuries or property damage. Comprehensive reporting helps maintain safety records.
The Social Security number is essential for background checks and verifying the driver's identity. It helps ensure that the information provided is accurate and complete.
Completing the form requires attention to detail. All information must be printed or typed clearly, ensuring that it is legible and accurately reflects the driver's qualifications.
Annual reviews of driving records are a legal requirement. They help employers monitor their drivers' safety and compliance with regulations over time.
Drivers have the right to review information provided by previous employers. They can request corrections if they find errors in their records, ensuring fairness in the hiring process.
This form must be updated regularly. Changes in employment, driving history, or medical status require new documentation to maintain compliance with regulations.
When filling out and using the Driver Qualification form, it is important to keep the following key takeaways in mind: