2022 - Driver Qualification File Questionnaire

Driver Qualification File Questionnaire

In accordance with FMCSA regulation 49 CFR 391.51 , ALL motor carriers must maintain a qualification file for EACH employed driver including owner–operators and mechanics that operate vehicles on public roads.
PLEASE COMPLETE EACH SECTION OF THE QUESTIONNAIRE - The information is required to complete your Driver Qualification File in accourdance with FMCSA regulation 49 CFR 391
REQUIRED COMPANY INFORMATION

information regarding the company under this DOT#
COMPANY LEGAL NAME*
COMPANY DOT#*
COMPANY EIN#
**OWNER/OPERATORS ONLY
COMPANY ADDRESS - physical address*

Street Address

Street Address Line 2

CityState

Zip Code
Drivers Basic Required Information

Motor carriers must ensure and verify that their CMV drivers meet the minimum requirements specified in 49 CFR 391.51 before operating a vehicle. CMV owner–operators must comply with both rules that apply to motor carriers and rules that apply to drivers.
Date Hired*

MonthDayYear
Date
Date of Application*

MonthDayYear
Date
Name*

FIRST NAMELAST NAME
Drivers Physical Address *

Street Address

Street Address Line 2

CityState

Zip Code
Drivers Phone Number*
Drivers E-mail Address*
SOCIAL SECURITY #*
DATE OF BIRTH *

MonthDayYear
Date
CDL Status*

NON CDL holderCDL HolderOther
Have you been at your current address for a minimum of 3 YEARS?*

YESNO - if no, please include 3 years of address history below
DRIVERS LICENSE INFROMATION

No person who operates a commercial motor vehicle shall at any time have more than one driver's license (49 CFR 383.21 I certify that I do not have more than one motor vehicle license, the information for which is listed below. ****Include all licenses held for the past 3 years****
License Type/Class*
example : CLASS A, CLASS D, etc
State License was Issued:*

Street Address

Street Address Line 2

CityState

Zip Code
Drivers License #*
*include any Alpha, Numeric & special characters
License Expiration Date*

MonthDayYear
The date your license will expire

*Required* Previous Address History
PREVIOUS THREE YEARS RESIDENCY

3 years of Address history is required by FMCSA rule 39 CFR 40*
Previous Physical Address

Street Address

Street Address Line 2

CityState

Zip Code
Cont. Previous Address History

Street Address

Street Address Line 2

CityState

Zip Code
Attach additional sheet if more space is needed

Drivers Previous Employment History - 3 years Required*
Drivers Previous Employment History

The FMCSA Regulations require that all applicants wishing to operate a commercial motor vehicle must list all employment for the last three (3) years. In addition, if you will be subject to operate a vehicle for this company that requires you to hold a valid commercial driver's license (Class A/Class B CDL), you must provide employment history for an additional seven (7) years [for a total of ten (10) years]. Any gaps in employment exceeding one (1) month must be explained. (Explanation should include but is not limited to; month/year & reason.) *Start with the most recent or current position (including any military experience) and work backwards. You are required to list the complete mailing address, including street number, city, state, zip and complete all other information requested below.
*Start with the most recent or current position (including any military experience) and work backwards. You are required to list the complete mailing address, including street number, city, state, zip and complete all other information requested below.
Most Recent Previous Employer
Company Name*
POSITION HELD
Address

Street Address

Street Address Line 2

CityState

Zip Code
Year Hired:
Year Left:
Reason for Leaving
ex: Resigned - Terminated - etc
DID YOU OPERATE A COMMERCIAL MOTOR VEHICLE FOR THIS COMPANY

YESNO
REQUIRED IF "YES" : Were you subject to DOT Drug and Alcohol Testing

YESNO
Prev. Employment History cont.
Company Name*
POSITION HELD
Address

Street Address

Street Address Line 2

CityState

Zip Code
Year Hired:
Year Left:
Reason for Leaving
ex: Resigned - Terminated - etc
DID YOU OPERATE A COMMERCIAL MOTOR VEHICLE FOR THIS COMPANY

YESNO
REQUIRED IF "YES" : Were you subject to DOT Drug and Alcohol Testing

YESNO
Please include any additional relevant Previous CMV Employment history below;

To Read and be Signed by Applicant/Driver
TO BE READ AND SIGNED BY APPLICANT

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, medical history, and other related matters as may be necessary in arriving at an employment decision.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to: Review information provided by current/previous employers; Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.
Name

First NameLast Name
Signature

Clear
Today's Date

MonthDayYear
Date
Applicant Name (printed)
Type a question
Should be Empty:

Driver Qualification File Questionnaire

REQUIRED COMPANY INFORMATION

Drivers Basic Required Information

DRIVERS LICENSE INFROMATION

PREVIOUS THREE YEARS RESIDENCY

Drivers Violation History

Drivers Driving History/Experience

Drivers Previous Employment History

Most Recent Previous Employer