HOS RECORD

HOURS OF SERVICE RECORD FOR FIRST TIME OR INTERMITTENT DRIVERS
Instructions:
When using a driver for the first time or intermittently, a signed statement must be obtained, giving the total time on duty (driving and on duty) during the immediate preceding seven days and the time at which the driver was last relieved from duty prior to beginning work.
FIRST Name*
MIDDLE Name*
LAST Name*
DAY TOTAL TIME ON DUTY
1.
2.
3.
4.
5.
6.
7.
Total
I hereby certify that the information contained herein is true to the best of my knowledge and belief, and that my last period of release from duty was from
From*
Hour/Date
To*
Hour/Date
Signature*

Clear
Date*

MonthDayYear
Date
WeGotThisTruckingLLC . 6262NorthSwanRoad,Suite200 Tucson,AZ85718,UnitedStates Phone:(737)400-5623
Should be Empty:

HOURS OF SERVICE RECORD FOR FIRST TIME OR INTERMITTENT DRIVERS