The Driver Qualification form serves as a comprehensive checklist designed to ensure that commercial driver applicants meet all necessary federal regulations and standards prior to employment. It encompasses a broad range of criteria, including employment history, medical examinations, driving records, and more, to establish a candidate's eligibility and qualification for driving roles. To streamline the hiring process and ensure compliance with safety standards, consider filling out the Driver Qualification form by clicking the button below.
In the realm of professional driving, especially within industries governed by stringent safety regulations, the Driver Qualification form stands as a cornerstone document, embodying critical regulatory and compliance frameworks. It meticulously encapsulates essential data points spanning a driver’s professional history, including but not limited to personal identification, employment history over the previous decade, a detailed account of driving licenses held over the last three years, and a comprehensive record of motor vehicle accidents and traffic violation convictions. This form also extends into inquiries regarding past employment and state agency checks, alongside mandatory medical examinations and road test certifications, to ensure an individual's suitability and compliance with occupational standards. Interspersed within these components are layers of regulatory safeguards designed to uphold not only the safety of the driver but also that of the general public, by mandating annual reviews of a driver's record and violation certificates. Importantly, this form facilitates a transparent communication channel between prospective employers and candidates, offering drivers the right to access and rectify information, thereby safeguarding the integrity of the data and the fairness of the employment process. Crafted with the intent to foster safety, compliance, and transparency, the Driver Qualification form is an indispensable tool in the hiring process within the commercial driving sector.
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 critical step in ensuring compliance with federal regulations for operating commercial vehicles. This form gathers essential information about a driver's qualifications, experience, and driving record to ascertain their suitability for driving duties. Below is a step-by-step guide to completing the form correctly.
Note that drivers must be issued copies of their Medical Examiner's Certificate and Certification of Road Test, essential documents proving their qualification and ability to operate commercial vehicles safely. Keeping these records up-to-date and readily available ensures that both drivers and their employers remain in compliance with applicable regulations.
A Driver Qualification File (DQF) is a set of documents that employers of commercial drivers are required to maintain under US Federal regulations. These files include detailed information on a driver’s eligibility, such as their application for employment, driving record, medical certificate, and records of any road tests taken. The importance of maintaining a DQF lies in its role in ensuring that drivers have the necessary qualifications and health status to safely operate commercial vehicles, thereby contributing to road safety for all users.
The following documents are essential for a complete Driver Qualification File:
A Driver Qualification File requires regular updates to ensure all information is current and accurate. Key components that need annual updating include the Annual Driver’s Certificate of Violations and the Annual Review of Driving Record. Furthermore, any time there is a change in a driver’s medical status, employment status, or if a driver receives a new certification or undergoes additional tests, the file should be promptly updated to reflect these changes.
While Federal regulations specify what content must be included in a Driver Qualification File, they do not prescribe a specific format for how the information is organized or stored. Employers have the flexibility to create their own systems for maintaining these files, provided all required documents are easily accessible for review and are kept up to date. Employers may use digital or paper formats for their files, but must ensure secure and confidential storage of the information.
Filling out a Driver Qualification File correctly is crucial for compliance with regulations and ensuring safety on the roads. However, people often make mistakes when completing this essential documentation. Below are seven common errors to avoid.
Not providing complete personal information: Failing to fill in all sections of the Driver Application for Employment, including full name, address history for the past three years, contact numbers, and date of birth. This information is critical for background checks and verifying identity.
Omitting previous employment details: Not accurately listing employment history for the last 10 years, including gaps between jobs. This information is vital for evaluating experience and reliability.
Incomplete driver’s license data: Forgetting to include all driver’s license information held in the last three years, including state, number, and expiration dates. This is necessary for confirming legal driving status.
Skipping accident and violation history: Neglecting to report any accidents or traffic violation convictions within the last three years. Being transparent about past incidents is mandatory for assessing risk and safety.
Incorrect medical information: Failing to attach a copy of the Medical Examiner’s Certificate or, if applicable, a medical waiver. This oversight can question your fitness to drive.
Inadequately documenting the road test: Not properly certifying the Driver’s Road Test or the Certification of Road Test. Drivers must demonstrate competence to operate a commercial vehicle safely.
Forgetting to update annual records: Overlooking the Annual Driver’s Certificate of Violations and the Annual Review of Driving Record can lead to compliance issues and safety oversight.
To ensure accuracy and compliance, always review each section of the Driver Qualification File carefully, provide truthful and complete responses, and update records as required. This diligence not only meets regulatory requirements but also contributes to the overall safety and efficiency of transportation operations.
When compiling a comprehensive Driver Qualification File, various essential documents complement the Driver Qualification Form to ensure compliance with regulations and to thoroughly assess a driver's qualifications and history. These documents are critical for a detailed review of a driver’s background, health, and driving experience, supporting the vetting process efficiently and effectively.
The combination of these documents with the Driver Qualification Form creates a robust framework for evaluating a potential driver's eligibility and compliance with regulatory standards. Employers are encouraged to maintain these records meticulously to ensure safety and compliance within their operations.
The Driver Application for Employment closely resembles a standard Employment Application Form, where both gather comprehensive personal, educational, and professional information from candidates to assess their suitability for a job role.
Similar to the Inquiry to Previous Employers, a Professional Reference Check Form is also used to verify an applicant's employment history, performance, and conduct from past employers, ensuring their qualifications for the new position.
The Inquiry to State Agencies document is akin to a Background Check Authorization Form, permitting employers to verify a candidate’s legal and professional status within state records, including driving records and criminal history.
A Medical Examiner’s Certificate can be paralleled with a Pre-Employment Physical Form, where both are aimed at confirming an applicant's physical fitness and capability to perform job-related tasks without compromising health and safety standards.
The Driver’s Road Test document is analogous to a Skills Assessment Test used in various industries to evaluate a candidate's practical skills and proficiency directly related to the job requirements.
A Certification of Road Test mirrors a Certification of Skills Completion Form, recognizing and documenting that a candidate has successfully demonstrated required skills, in this case driving, under a standardized evaluation.
The Annual Driver’s Certificate of Violations is similar to an Annual Employee Performance Evaluation, where both involve a periodic review of the individual's performance and compliance with regulations, focusing on identifying areas of improvement.
Finally, the Annual Review of Driving Record compares to a Continuous Professional Development (CPD) Record, as both track the progress and any changes in the professional status or competencies of an individual over a given period.
When filling out the Driver Qualification form, there are specific do's and don'ts that applicants should be aware of to ensure that their application is accurately and effectively completed. Here is a list of five things you should do, followed by five things you shouldn't do.
Do:
Don't:
Many people hold incorrect beliefs about the Driver Qualification (DQ) Form and its requirements. Here, we're going to clarify some common misconceptions to ensure everyone understands what's truly involved.
Misconception #1: The DQ Form is only for drivers with a commercial driver's license (CDL). While it predominantly applies to CDL holders, the DQ form requirements can extend to non-CDL drivers, depending on their role and the type of vehicle they operate. This is especially true if they drive vehicles used for transporting goods or passengers in a professional capacity.
Misconception #2: One size fits all for the DQ Form. While the form follows federal guidelines, companies may need to add specific details or requirements based on the nature of their operations or state regulations. It's not a strictly standardized form; customization is often necessary.
Misconception #3: Paper documentation is outdated. Even in a digital age, many companies are required to keep paper records of the DQ Form and all accompanying documents. This ensures compliance with audit processes and provides a tangible record in case of electronic failure.
Misconception #4: Drivers are responsible for maintaining their DQ Files. It's actually the employer's responsibility to maintain up-to-date DQ Files for all drivers. Drivers must provide necessary information and documents, but it is up to the employer to organize and keep these files compliant.
Misconception #5: Only current driving violations matter. When filling out the DQ Form, drivers must disclose any driving violations over the past three years, not just those from their current employment. This comprehensive history helps ensure that only qualified individuals operate commercial vehicles.
Misconception #6: Once completed, the DQ form doesn't need to be updated. Drivers and employers must update DQ forms annually. This includes revisiting the medical examiner's certificate and ensuring all information, including driving records and any violations, are current.
Misconception #7: The DQ File is the only record that matters. While the DQ File is critical, employers must also maintain additional records, such as records of drug and alcohol testing under DOT regulations, to ensure comprehensive compliance. This broader documentation supports the safety and qualification of drivers beyond what's contained in the DQ File alone.
Understanding these nuances ensures that both drivers and employers can better navigate federal requirements and maintain compliance, contributing to the safety and efficiency of transportation operations.
Filling out and using the Driver Qualification (DQ) form is a critical process that ensures the safety and compliance of commercial driving operations. Below are key takeaways to guide employers and drivers through this essential documentation process.
The diligence in completing and updating the Driver Qualification form reflects an overarching commitment to safety, legal compliance, and the well-being of both drivers and the public on the roads.
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