The Driver Qualification form is a comprehensive checklist designed to ensure that commercial drivers meet all required federal standards before they are hired. It includes sections for personal information, employment history, drug and alcohol testing, and driving records, among others. For a smooth recruitment process and to ensure compliance with all regulations, it's essential that employers carefully complete and maintain these forms. Click the button below to learn more about filling out the form effectively.
Ensuring the safety and compliance of commercial drivers is a critical responsibility for employers in the transportation sector. The Driver Qualification File Checklist serves as a comprehensive roadmap to meeting federal guidelines, encapsulating everything from the driver's application for employment to detailed inquiries into their previous work and driving history. It requires a meticulous review of the applicant’s driving record, medical examiner's certificate, and even their history with past employers over a three-year period. Furthermore, it mandates the examination of the driver’s road test performance and the annual certification of any violations they may have accrued. This documentation also extends to include the driver's personal information, experience, and any incidents or violations that have taken place in the last three years. With such a rigorous compilation of data, the checklist not only promotes safety on the roads but also encourages a culture of transparency and accountability within the logistics and transportation industry. By adhering to these regulations, employers can ensure they are hiring qualified drivers who are capable of upholding the standards required for both public and environmental safety.
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
8
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
9
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.
10
Filling out the Driver Qualification form is a crucial step for individuals seeking employment that requires driving commercial vehicles. It's designed to ensure that all drivers meet the necessary standards for safety and compliance set forth by regulations. By accurately completing this form, applicants demonstrate their qualifications and readiness to adhere to safety protocols. The following steps provide a guide on how to properly fill out the form.
After completing the form, review all the information you have provided to ensure accuracy and completeness. Submit the form to the prospective employer or the designated official as directed. Remember, this form is a key component of your qualification process, and accuracy is essential for meeting the regulatory compliance and safety standards of the driving profession.
What is a Driver Qualification File and why is it necessary?
A Driver Qualification File is a set of documents that employers are required to maintain for all their commercial drivers. This file proves that a driver is qualified to operate a commercial motor vehicle (CMV). The necessity stems from regulations set forth by the Federal Motor Carrier Safety Administration (FMCSA), particularly to ensure safety and compliance with the law. These files help in verifying the driver’s license, experience, medical fitness, and history of any traffic violations or accidents.
What documents are included in a Driver Qualification File?
The Driver Qualification File includes several critical documents, such as the driver application for employment, inquiries to previous employers and to state agencies regarding the driver’s safety performance and driving record, the medical examiner’s certificate (and any waiver, if issued), the driver’s road test and certification of road test, the annual driver’s certificate of violations, and the annual review of driving record. For drivers who work or have worked for multiple employers, a checklist for multiple employers is also included.
Do drivers need to carry the Medical Examiner’s Certificate with them at all times?
Yes, drivers must have a copy of the Medical Examiner’s Certificate in their possession while driving a commercial motor vehicle. It is a crucial piece of documentation that verifies the driver meets the physical qualifications necessary to operate a CMV safely. Failure to have this certificate while driving may result in penalties or being prohibited from driving until the certificate can be presented.
How often should the Driver Qualification File be updated or reviewed?
The Driver Qualification File should be reviewed and updated at least annually. The review should include checking the driver’s driving record for any new violations or suspensions, ensuring the Medical Examiner’s Certificate is still valid, and updating the annual certificate of violations. Besides the annual review, documents should be updated as necessary, such as when a driver completes a new road test, has a change in medical status, or when there is new employment information.
Filling out the Driver Qualification form is a critical step in ensuring that drivers meet all required qualifications for the job. However, mistakes can happen. One common error is the incomplete filling of personal information, including the full address history for the past three years. This is crucial for a thorough background check and to comply with 391.21 regulations. Ensuring all blanks are filled with accurate information requires careful attention to detail.
Another mistake involves the employment history section. Drivers often overlook the requirement to account for employment gaps. Any period of unemployment or self-employment must be clearly documented to meet 383.35 requirements. This comprehensive employment history over the last ten years is pivotal for employers to assess a candidate’s experience and reliability.
When it comes to listing all traffic violations, accidents, or incidents, drivers sometimes underestimate the significance of complete honesty. Some may fail to disclose minor violations or accidents, not realizing this can lead to more serious repercussions down the line. It's a requirement that any and all incidents in the last three years, regardless of their nature, be listed in accordance with sections like 391.27 and 391.25, aiming to assess the driver's safety record accurately.
Incorrect or outdated driver’s license information is yet another common mistake. This includes not only the license number and expiration date but also ensuring that all licenses held in the last three years are reported. This is critical for verifying the driver's legal ability to operate a vehicle across different states.
Applicants often fail to provide sufficient details about their previous employers or the type of vehicle driven, along with the approximate mileage. This information is not only crucial for verifying experience but also for compliance with specific Federal Motor Carrier Safety Regulations. Every detail contributes to creating a comprehensive profile of the driver’s qualifications and experience.
A significant error that can occur is not properly disclosing the controlled substance and alcohol status as required by 49 CFR part 40.25(j) for drivers of commercial motor vehicles requiring a Commercial Driver License (CDL). This disclosure is crucial for safety and legal compliance and must be handled with utmost honesty and accuracy.
Completing the certification section at the end of the application and ensuring that the applicant's signature and date are present is sometimes overlooked. This certification is the applicant's assertion that all information provided is true and complete to the best of their knowledge, serving as a legal attestation to the accuracy of the application.
The final common mistake involves not utilizing the rights to review information provided by previous employers. Applicants might not realize they can request this information, which allows them to verify accuracy and address any discrepancies. This oversight can miss an opportunity to ensure a fair evaluation process based on accurate and complete historical employment data.
When completing the Driver Qualification File, several essential documents compliment the Driver Qualification Form, ensuring compliance and thorough evaluation of a driver's credentials, history, and suitability for employment in a driving capacity. These documents play a crucial role in maintaining high safety standards and regulatory compliance within the transportation industry.
Each of these documents plays a vital role in ensuring that the hiring process for drivers is thorough, regulatory-compliant, and oriented towards safety. Companies that diligently complete and maintain these records not only comply with legal requirements but also contribute to safer roadways by ensuring their drivers are qualified and well-vetted.
The Driver Application for Employment bears similarity to a standard employment application used in various industries outside of transportation. Both documents collect comprehensive personal and professional details, including past employment, education, and contact information. They serve as the foundation for evaluating an applicant's qualifications and experience for a job position. Both forms typically require information about the applicant's address history, job experience, and reasons for leaving previous positions, providing employers with a thorough background for making informed hiring decisions.
Inquiry to Previous Employers (3 years) mirrors the reference check process common in many hiring procedures. This step involves contacting an applicant's former employers to verify employment history and assess the applicant's job performance. Similar to conducting reference checks, this inquiry helps to ensure that the information provided by the applicant is accurate and to gain insights into their work ethic, skills, and experiences from previous roles.
The Inquiry to State Agencies process is akin to background checks conducted for various positions across different sectors. This check ensures compliance with regulations and assesses any legal issues or past transgressions that might affect the applicant’s eligibility or suitability for the role. Like standard background checks, this step is crucial for evaluating the risk and integrity associated with the prospective candidate.
The Medical Examiner’s Certificate is parallel to health assessments or medical exams required in professions with physical demands or safety considerations. These assessments ensure that individuals are physically capable of performing their job without risking their or others' health and safety. Both documents are preventive measures that certify an individual's health status aligns with the job requirements, particularly in roles where physical wellness is crucial.
Driver’s Road Test and the Certification of Road Test align with practical assessments or skills tests in various fields, designed to evaluate an applicant's practical abilities and competencies in real-world scenarios. Such evaluations ensure that the candidate possesses the necessary skills and knowledge to perform the job effectively, similar to how practical exams in other careers assess proficiency and readiness for the role.
The Annual Driver’s Certificate of Violations resembles performance reviews or disciplinary records used in other industries to monitor an employee’s conduct and compliance with job standards over time. This document tracks any violations or infractions, serving as a record of an employee’s adherence to rules and regulations crucial for safety and operational efficiency. Monitoring these aspects is common across different job roles to maintain high standards of professional conduct.
Finally, the Annual Review of Driving Record is comparable to continuous performance evaluations in other careers, where an employee’s work history and behavior are periodically reviewed to ensure ongoing compliance with company standards and regulations. This ongoing assessment is vital for identifying areas of improvement and maintaining high standards of professional performance across various occupations.
When preparing to fill out the Driver Qualification form, ensuring accuracy and completeness is key. Here are some essential do's and don'ts to keep in mind:
Following these guidelines will help ensure your Driver Qualification form is filled out correctly and completely, reflecting your qualifications accurately and comprehensively.
There are several misconceptions about the Driver Qualification (DQ) file process, which can lead to confusion for both employers and drivers alike. Understanding these common fallacies can help ensure compliance with the regulations and a smoother qualification process for all involved.
Many believe that possessing a valid driver's license is sufficient for driver qualification. However, the DQ file requires much more than just a driver’s license. According to the checklist, in addition to driver’s license information, employers must also collect an application for employment, inquiries to previous employers and state agencies, a medical examiner's certificate, and road test certification, among other documents. These requirements ensure a comprehensive review of the driver’s qualifications and health status.
There’s a common myth that only the driver's current driving status and records are relevant. On the contrary, the DQ file checklist mandates inquiries to previous employers for the past three years and an annual review of the driving record. This thorough background check helps employers assess the driver’s behavior and performance over time, providing a more complete understanding of their driving history.
Some might think that once a driver passes the initial medical examination and obtains their medical examiner's certificate, there's no need for further medical assessment. This is incorrect. The requirement for drivers to carry a valid medical examiner’s certificate and for employers to have these on file, along with the fact that these certificates have an expiration date, underscores the necessity for periodic medical evaluations to ensure ongoing fitness for duty.
A significant misunderstanding is the belief that a driver applicant's employment history and drug and alcohol testing results from previous employers are irrelevant. The reality, as stated in the application form requirements, is quite the opposite. Applicants must account for their employment history over the last ten years and disclose their controlled substance and alcohol status as per the requirements of 49 CFR part 40.25(j). This information is crucial for assessing an applicant's reliability and safety as a driver.
Clarifying these misconceptions is key to ensuring both employers and drivers adhere to the Federal Motor Carrier Safety Regulations, promoting a safer driving environment for everyone on the road.
Filling out the Driver Qualification form is a critical process for those seeking to drive commercially. Understanding the key aspects of this form can ensure compliance with federal regulations and help streamline the hiring process. Here are some vital takeaways to consider:
Understanding and meticulously completing the Driver Qualification form is not just about fulfilling a requirement; it's about ensuring safety on the roads by verifying the credentials and history of those behind the wheel of commercial vehicles. Compliance with these guidelines benefits everyone on the road.
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