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Driver Onboarding Checklist(Checklist to be filed in Personnel File)10/20/2020Initial Driver Qualification File Documents – All Forms Sent to Human ResourcesRetentionLife of employment 3 years afterterminationLife of employment 3 years afterterminationForm #1DescriptionDriver Application for Employment(10 years of employment history must be provided. All employmentgaps must be explained.) **Online or Print Hardcopy if necessary1.1Use the Declaration of Employment Status form to certify any gapsof employment. (Reg 391.21)2Inquiry to Previous Employers – 3 yearsInquiries MUST be sent to previous employers for preceding 3years. This MUST be completed within 30 days of the dateemployment begins. 3 attempts to each previous employer mustbe documented.*Make additional copies as necessary (Reg 391.23)Life of employment 3 years aftertermination3Examiner Certification of Road Test and Record of Road TestA person must not be allowed to drive a commercial motor vehicle untilhe/she has successfully completed a road test. (Reg 391.31 (e))Current4Copy of Med Card - Medical Examination Report Form(Long Form, if provided can be put in HR Medical File. It should NOTbe stored in the DQ file.) (Reg 391.43)ResponsibleApplicant(Manager toverify 10years ofhistory listed)Manager toensure this isform iscompleted forEACHpreviousemployer inlast 3 yearsManagerManager tosend to HRHR to record expiration in Workforce Ready system3 yearsMedical Examiner – VerificationA note must be included in the driver’s qualification file to verify that themedical examiner is listed on the National Registry of Certified MedicalExaminers. (Reg 391.51)HumanResourcesCurrentDrug screenHumanResourcesCopy of Driver’s License – Front and BackHR to record expiration in Workforce Ready systemManager tosend to HRCurrent5Life of employment 3 years afterterminationClearinghouse – Full Query Results– New Hires Only**Manager: Remind Driver to register on Clearinghouse andAuthorize Consent for RDWLife of employment 3 years afterterminationBackground & MVR Results – New Hire MVR must be maintainedfor life of DQ file(Authorization is given in application process online)(Paper authorization must be filled out if not applying online)PSP Results – New Hire(Authorization is given in application process online)(Paper authorization must be filled out if not applying online)Life of employment 3 years afterterminationManagerHR to RunFull QueryManager tosend signedform to HRManager tosend signedform to HRLife of employment 3 years aftertermination6Authorization Form to Obtain Annual and PeriodicMotor Vehicle Record (MVR)Manager tosend signedform to HRLife of employment 3 years aftertermination7Clearinghouse - General Consent for Limited Queries FormManager tosend signedform to HRCompleted
Other Items To be Filed with Personnel File(Checklist to be filed in Personnel File (not DQ file)DescriptionSafe Hiring Driver Evaluation - Review of PSP and MVR Records(added 9/2020 – PSP report)Life ofemployment 7yearsLife ofemployment 7yearsLife ofemployment 7yearsLife ofemployment 7yearsLife ofemployment 7yearsLife ofemployment 7yearsLife ofemployment 7yearsLife ofemployment 7yearsDate SentPSP Consent Form and Fair Credit Reporting BackgroundAuthorization Form (Background and Initial MVR) - Online8Notice to Drivers and Driver’s Certification of Other CompensatedWork (Reg 395.2)9On-Duty Hours Certification10Mobile Phone Use Notice and Acknowledgement11DOT Controlled Substance and Alcohol Policy andAcknowledgement12FMCSA Pocketbook Acknowledgement13Certification of Compliance with Driver License RequirementsHUMAN RESOURCES ONLYInquiry to Previous EmployersEmployerDate ReceivedResponsibleHR to completeand shareresults of PSPand MVRHR –ApplicationProcessManager tosend signedform to HRManager tosend signedform to HRManager tosend signedform to HRManager tosend signedform to HRManager tosend signedform to HRManager tosend signedform to HRCompletedFax / Email
‘Retention3 years3 yearsDriver Qualification Checklist – Ongoing Updates(Checklist to be filed in Personnel File (not DQ file)DescriptionInquiry To State Agencies (MVR) – 3 YearsThe driver’s driving record for the preceding three years within first 30days of hire and annually thereafter and when a new medical card isreceived by the driver. (Reg 391.23)Original MVR must be maintained during life of DQ file.3 years of MVRs must be maintained thereafter.Annual Driver’s Certification Of ViolationsAt least once every 12 months, a motor carrier must require each driverthat it employs to prepare and furnish it with a list of all violations of motorvehicle traffic laws and ordinances during the previous 12 months.(Reg 391.27)Annual Review of Driving Record compared to Annual MVRAt least once every 12 months, a motor carrier must review the drivingrecord of each driver. A note stating the results of this review shall beincluded in the Driver’s Qualification File(Reg 391.25)3 yearsMedical Examination Report Form(Long Form, if provided can be put in HR Medical File. It should NOT bestored in the DQ file.) **Remember to run new MVR as well (listed above)(Reg 391.43)Provide to HR to record expiration in Workforce Ready system HR tosend to Fleet ManagerResponsibleHR providesFleet ManagerTransportationManagers /DriverFleet ManagerManager to sendto HRHR to run newMVR and verifyMed Examiner3 yearsMedical Examiner – VerificationA note must be included in the driver’s qualification file to verify that themedical examiner is listed on the National Registry of Certified MedicalExaminers. (Reg 391.51)Fleet Manager3 yearsAnnual Limited Query Clearinghouse ReportLimited Query Authorization signed once. 3 years of searches on file.Clearinghouse began January 2020. Limited Query Auth signed at hireFleet Manager/HRCurrentCopy (Front and Back) of current operator license.Send to Fleet Manager.Provide to HR to record expiration in Workforce Ready system HR tosend to Fleet ManagerTransportationManagerHRCompleted
DRIVER EMPLOYMENT APPLICATIONRUSS DAVIS WHOLESALEAn Equal Opportunity Employerhr@russdaviswholesale.comCOMPLETE IN FULL OR IT WILL NOT BE CONSIDERED - This application contains all information required by 49 CFR 391.21.APPLICANT INFORMATIONFIRST NAMEMIDDLENAMEPHONEEMAILDATE OF BIRTHSOCIAL SECURITY #DATE OFAPPLICATIONLASTNAMEPOSITIONAPPLIED FORDATE AVAILABLEFOR WORKDo you have legal right to work in the United States?YESNOPREVIOUS THREE YEARS RESIDENCYAttach additional sheet if more space is neededSTREETCITYSTATEZIPCODE# OF YEARSAT SE INFORMATIONNo 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 donot have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attachadditional sheets if needed.STATELICENSE #TYPE/CLASSEXPIRATIONDATEENDORSEMENTSPREVOIUSLY HELD LICENSESDRIVING EXPERIENCECLASS OFEQUIPMENTTYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC.)DATE FROMDATE TOAPPROX # OFMILES (TOTAL)STRAIGHTTRUCKTRACTOR &SEMI-TRAILERTRACTOR &2 TRAILERSTRACTOR &TANKEROTHERPage 1 of 4
ACCIDENT RECORD FOR THE PAST 3 YEARSAttach additional sheet if more space is needed. Check this box if none DATES(List mostrecent first)NATURE OF ACCIDENT (Head-on, rear-end, upset, etc.)# FATALITIES # INJURIESCHEMICAL SPILLS(Y/N)TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)Attach additional sheet if more space is needed. Check this box if none DATECONVICTED(Month/Year)STATE OFVIOLATIONVIOLATIONPENALTY (Forfeited bond, collateral and/or points)Have you ever been denied a license, permit, or privilege to operate a motor vehicle? YES NO YES NOIf yes, explainHas any license, permit, or privilege ever been suspended or revoked?If yes, explainEMPLOYMENT HISTORYZThe Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list allemployment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provideemployment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1)month must be explained.Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary).You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.CURRENT (MOST RECENT) EMPLOYERNAMEPHONEADDRESSPOSITION HELDREASON FOR LEAVINGFROMTOMO/YRMO/YRSALARYEXPLAIN ANY GAPS INEMPLOYMENT (Includemonth/year & reason)Page 2 of 4
While employed here, were you subject to the Federal Motor Carrier Safety Regulations? YES NOWas the job designated as a safety-sensitive function in any Department of Transportation-regulatedmode subject to alcohol and controlled substances testing as required by 49 CFR, part 40? YES NOWhile employed here, were you subject to the Federal Motor Carrier Safety Regulations? YES NOWas the job designated as a safety-sensitive function in any Department of Transportation-regulatedmode subject to alcohol and controlled substances testing as required by 49 CFR, part 40? YES NOWhile employed here, were you subject to the Federal Motor Carrier Safety Regulations? YES NOWas the job designated as a safety-sensitive function in any Department of Transportation-regulatedmode subject to alcohol and controlled substances testing as required by 49 CFR, part 40? YES NOSECOND (MOST RECENT) EMPLOYERNAMEPHONEADDRESSPOSITION HELDFROMTOMO/YRMO/YRREASON FOR LEAVINGSALARYEXPLAIN ANY GAPS INEMPLOYMENT (Includemonth/year & reason)THIRD (MOST RECENT) EMPLOYERNAMEPHONEADDRESSPOSITION HELDFROMTOMO/YRMO/YRREASON FOR LEAVINGSALARYEXPLAIN ANY GAPS INEMPLOYMENT (Includemonth/year & reason)EDUCATIONSCHOOLNAME & LOCATIONCOURSE OF STUDYYEARSCOMPLETEDGRADUATEYN High SchoolCollegeOtherDETAILS OTHER QUALIFICATIONSPlease list any other qualifications that you have and which you believe should be considered.Page 3 of 4
TO BE READ AND SIGNED BY APPLICANTI authorize you to make investigations (including contacting current and prior employers) into my personal, employment,financial, medical history, and other related matters as may be necessary in arriving at an employment decision. I herebyrelease employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasinginformation in connection with my application.In the event of employment, I understand that false or misleading information given in my application or interview(s) mayresult 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 understandthat 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 thecorrected information to the prospective employer; and Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannotagree 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 bestof my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by theFederal Motor Carrier Safety Regulations.Applicant SignatureDateApplicant Name (printed)Page 4 of 4
Driver Qualification File1DECLARATION OF EMPLOYMENT STATUSRuss Davis Wholesale is required to verify employment background of all potential drivers underthe Federal Motor Carrier Safety Regulations, Part 391.23. On your application, you indicatedthat you were unemployed or self-employed during the time period(s) below. This form isdesigned to enable you to account for those period(s) of time that cannot be verified by any othermeans.Please fill in the applicable dates and describe your activities during this time:Date(s):FromToDuring this period, I was engaged in the following activities:In addition, during this time, the below statements are also true:I was not employed on full-time or part-time basis.I was self-employed asDuring this time, I did not receive any unemployment compensation.I was not convicted of any crime or felony, nor is there a charge pending.During this time, I was not involved in a motor vehicle accident of any type.Listed below are two, non-related, individuals, who can verify the above information andstatements are true.Name:Address:Phone:Name:Address:Phone:I hereby authorize you to contact them and further authorize the release of any necessaryinformation.Printed NameSignatureDateRevision: 001Date: 01/2020Author: Nicole O’Connellflt-19 (declaration of employment status)
2 Driver Qualification FileINQUIRY TO PAST EMPLOYERStatement of Release:Driver Name: Social Security #:I hereby authorizeto release the following information toRuss Davis Wholesale to investigate and qualify me to drive and operate a commercial vehicle asrequired by the U.S. Department of Transportation and Federal Motor Carrier Safety RegulationsParts 382, 391, 392, 49 CFR Part 40.Driver Signature: Date:Employee Work History: (If current employer – may we contact immediately?)Employed fromtoas aDid the employee drive a motor vehicle? YesIf yes, please indicate specific type(s) and time driven:Tractor/TrailerStraight TruckOther (Please specify)Special Equipment Used:Was the employee a safe and efficient driver? YesList all accidents and violations applicable: No NoReason for leaving: Discharged Other (specify):Is the employee eligible for rehire? YesNo NoWas the employee’s general conduct satisfactory? Yes Resigned Lay OffYes NoDrug & Alcohol Information:Note: DOT Regulations (49 CFR Part 40) requires your company to provide information regarding thename employee’s past drug & alcohol results, including any refusals to be tested.In the past 3 years has the previous employee ever: Tested positive for a controlled substance? Yes No If Yes, Dates: Tested with an alcohol concentration of 0.04 or higher? Yes No If Yes, Dates: Refused to submit a DOT required drug/alcohol test, including a verified adulterated or substitutionresult? Yes No If Yes, Dates: Had any other violations of DOT drug/alcohol testing regulations? Yes No If Yes, Dates:Name:Title:Company:Date:Please email or fax your response as soon as possible to 715-309-5284 or hr@russdaviswholesale.comRDW Revision Date: 1/3/2020
2 Driver Qualification FileINQUIRY TO PAST EMPLOYERStatement of Release:Driver Name: Social Security #:I hereby authorizeto release the following information toRuss Davis Wholesale to investigate and qualify me to drive and operate a commercial vehicle asrequired by the U.S. Department of Transportation and Federal Motor Carrier Safety RegulationsParts 382, 391, 392, 49 CFR Part 40.Driver Signature: Date:Employee Work History: (If current employer – may we contact immediately?)Employed fromtoas aDid the employee drive a motor vehicle? YesIf yes, please indicate specific type(s) and time driven:Tractor/TrailerStraight TruckOther (Please specify)Special Equipment Used:Was the employee a safe and efficient driver? YesList all accidents and violations applicable: No NoReason for leaving: Discharged Other (specify):Is the employee eligible for rehire? YesNo NoWas the employee’s general conduct satisfactory? Yes Resigned Lay OffYes NoDrug & Alcohol Information:Note: DOT Regulations (49 CFR Part 40) requires your company to provide information regarding thename employee’s past drug & alcohol results, including any refusals to be tested.In the past 3 years has the previous employee ever: Tested positive for a controlled substance? Yes No If Yes, Dates: Tested with an alcohol concentration of 0.04 or higher? Yes No If Yes, Dates: Refused to submit a DOT required drug/alcohol test, including a verified adulterated or substitutionresult? Yes No If Yes, Dates: Had any other violations of DOT drug/alcohol testing regulations? Yes No If Yes, Dates:Name:Title:Company:Date:Please email or fax your response as soon as possible to 715-309-5284 or hr@russdaviswholesale.comRDW Revision Date: 1/3/2020
2 Driver Qualification FileINQUIRY TO PAST EMPLOYERStatement of Release:Driver Name: Social Security #:I hereby authorizeto release the following information toRuss Davis Wholesale to investigate and qualify me to drive and operate a commercial vehicle asrequired by the U.S. Department of Transportation and Federal Motor Carrier Safety RegulationsParts 382, 391, 392, 49 CFR Part 40.Driver Signature: Date:Employee Work History: (If current employer – may we contact immediately?)Employed fromtoas aDid the employee drive a motor vehicle? YesIf yes, please indicate specific type(s) and time driven:Tractor/TrailerStraight TruckOther (Please specify)Special Equipment Used:Was the employee a safe and efficient driver? YesList all accidents and violations applicable: No NoReason for leaving: Discharged Other (specify):Is the employee eligible for rehire? YesNo NoWas the employee’s general conduct satisfactory? Yes Resigned Lay OffYes NoDrug & Alcohol Information:Note: DOT Regulations (49 CFR Part 40) requires your company to provide information regarding thename employee’s past drug & alcohol results, including any refusals to be tested.In the past 3 years has the previous employee ever: Tested positive for a controlled substance? Yes No If Yes, Dates: Tested with an alcohol concentration of 0.04 or higher? Yes No If Yes, Dates: Refused to submit a DOT required drug/alcohol test, including a verified adulterated or substitutionresult? Yes No If Yes, Dates: Had any other violations of DOT drug/alcohol testing regulations? Yes No If Yes, Dates:Name:Title:Company:Date:Please email or fax your response as soon as possible to 715-309-5284 or hr@russdaviswholesale.comRDW Revision Date: 1/3/2020
3 Driver Qualification FileRECORD OF ROAD TESTDriver’s NameHome AddressSocial Security No.License NoCityStateZipStateClassEquipment Driven:Truck Tractor (Make & Model)Trailer(s) (Body Type & Length of Each)Length of TestMi. From/InToStart TimeFinish TimeWeather Conditions-Instructions to Evaluator: Check items which the driver performs satisfactorily, use where performance isunsatisfactory. Any item not evaluated, leave blank.Part 1 - Pre-Trip Inspection and Emergency EquipmentPart 3 - Placing Vehicle In Motion And Use OfControlsChecks general condition approaching unitA. MOTORChecks fuel, oil, water and for excessive oil on enginePlaces transmission in neutral before startingengineChecks around unit - Tires, lights, trailer hook-up, brakeStarts engine without difficultyand light line, doors and inspects for body damageTests steering, brake action, tractor protection valve, andChecks instruments at regular intervalsparking brakeChecks horn, windshield wipers, mirrors, emergencyMaintains proper engine RPM while drivingequipment; reflectors, flares, fuses, tire chains (ifnecessary), fire equipmentChecks instruments for normal readingsB. BRAKESChecks dashboard warning lights for proper functioningKnows proper use of and checks tractorprotection valve (trailer air supply valveCleans windshield, windows, mirrors, lights and reflectorsTests service brakesReviews and signs previous reportBuilds full air pressure before movingPart 2 - Coupling and UncouplingC. CLUTCH AND TRANSMISSIONConnects glad hands to trailer to apply trailer brakesbefore couplingStarts unit moving smoothlyConnects glad hands and light line properlyUses clutch properlyCouples without difficultyRaises landing gear fully after couplingVisually checks king pin assembly to be certain ofproper couplingChecks coupling by applying hand valve or tractorprotection valve (trailer air supply valve) and gentlyapplying pressure by trying to pull away from trailerAssures himself that surface will support trailerbefore uncouplingD. LIGHTS (if tested at night)Adjusts speed for range of headlightsDims lights when approaching anothervehicle or following other traffic
Part 4 - Backing and ParkingA. BACKINGGets out and checks area before backingUnderstands and utilizes mirrors properlySignals when backing (if appropriate)Avoids backing from blind sideB. PARKING (CITY)Parks without hitting any other vehicles or stationaryobjectsPart 6 - Operating In Traffic, Passing and TurningA. TURNINGSignals intention to turn well in advanceGets into proper lane well in advance of turnChecks traffic conditions and turns only whenintersection is clearRestricts traffic from passing on right whenpreparing to complete right-hand turnCompletes turn promptly and safely and does notimpede other trafficB. TRAFFIC SIGNS AND SIGNALSParks correct distance from curbPlans stop in advance and adjusts speedcorrectlySecures unit properly - sets parking brake, transmission incorrect gear, shuts off engine, blocks wheels (whennecessary)Carefully enters traffic from parked positionC. PARKING (ROAD)Parks off pavementSecures unit properlyObeys all traffic signalsUses emergency warning signal or devices whennecessaryPart 5 - Slowing and StoppingUses clutch and gears properlyGears down properly before descending hillsStarts without rolling backTests brakes before descending gradesUses brakes properly on gradesMakes proper use of mirrorsPlans stop far enough in advance to avoid hardbrakingStops clear of crosswalksPart 7 - MiscellaneousA. GENERAL DRIVING ABILITY AND HABITSConsistently alert and attentiveConsistently is aware of changing traffic conditionsAnticipates problemsPerforms routine functions without taking eyes from roadChecks instruments regularly while drivingRemains calm under pressureB. USE OF SPECIAL EQUIPMENT (SPECIFY)Pallet JackComes to a complete stop at all stop signsC. INTERSECTIONSYields right of wayChecks for cross traffic regardless of trafficcontrolsEnters all intersections prepared to stop ifnecessaryD. GRADE CROSSINGSStops at a minimum 15 feet but not more than 50feet before crossing if stop is necessarySelects proper gear and does not shift gearswhile crossingKnows and understands Federal and State rulesgoverning grade crossingsE. PASSINGAllows sufficient space ahead for passingPasses only in safe locationsSignals changing lanes before and after passingWarns driver ahead of his intention to passPasses with sufficient speed differential tominimize obstructing trafficReturns to right lane promptly when safe to do soF. SPEEDObserves speed limitsDrives at speed consistent with abilityAdjusts speed properly to road, weather andtraffic conditionsSlows down in advance of curves, danger zonesand intersectionsMaintains constant speed where possibleG. COURTESY AND SAFETYYields right of wayConsistently strives to drive in safe mannerAllows faster traffic to passUses horn only when necessaryRevision: 001Date: 01/2020Author: Nicole O’Connell
Driver Qualification File3CERTIFICATION OF ROAD TESTDriver’s NameLicense NumberStateType of Power UnitType of Trailer(s)This is to certify the above-named driver was given a road test under my supervision on, 20 consisting of approximately miles of driving.It is my considered opinion that this driver possesses sufficient driving skill to operate safely the type ofcommercial motor vehicle listed above.Examiner’s SignatureTitleExaminer’s NameEQUIVALENT OF ROAD TEST FOR CDL DRIVERS§391.33 Equivalent of Road TestA. In place of, and as equivalent to, the road test required by §391.31, a person who seeks to drive a motor vehiclemay present, and a motor carrier may accept -1)A valid operator’s license which has been issued to him by a State that licenses drivers to operate specificcategories of motor vehicles and which, under the laws of that State, licenses him after successfulcompletion of a road test in a motor vehicle of the type the motor carrier intends to assign to him; or2)A copy of a valid certificate of driver’s road test issued to him pursuant to §391.31 within the preceding 3years.B. If a driver presents, and a motor carrier accepts, a license or certificate as equivalent to the road test, the motorcarrier shall retain a legible copy of the license or certificate in its files as part of the driver’s qualification file.C. A motor carrier may require any person who presents a license or certificate as equivalent to the road test totake a road test or any other test of his driving skill as a condition to his employment as a driver.Revision: 001Date: 01/2020Author: Nicole O’Connell
4 Driver Qualification FileFEDERAL MOTOR CARRIER CARDCopy of Federal Motor Carrier Wallet Card.**Reminder to Verify Medical Examiner on the National Registry of Certified MedicalExaminers.If Long Form is provided, this should be sent to Human Resources and should not beplaced in the DOT Qualification File.Revision: 001Date: 01/2020Author: Nicole O’Connell
5 Driver Qualification FileCOPY OF OPERATOR LICENSECopy of Operator License – Front and BackRevision: 001Date: 01/2020Author: Nicole O’Connell
6 Driver Qualification FileAUTHORIZATION TO OBTAIN MOTOR VEHICLE RECORDTHE UNDERSIGNED DOES HEREBY ACKNOWLEDGE AND CERTIFY AS FOLLOWS:1. Certifies that the undersigned is an employee or owner-operator, or has applied to becomean employee of the below named employer in a position which involves the operation of amotor vehicle and the undersigned gives his or her consent to the release of their drivingrecord (MVR) for review:RUSS DAVIS WHOLESALE(including BlackJack Express/Truck & Trailer)2. That the undersigned authorizes his or her driving record to be periodically obtained andreview for the purpose of initial and continued employment (Annual Review of DrivingRecord, Section 391.25)3. That all information presented in this form is true and correct. The undersigned makes thiscertification and affirmation under penalty of perjury and understands that knowinglymaking a false statement or representation on this form is a criminal violation.Name of Employee/Owner Operator/Applicant:Print name as it appears on driver’s licenseAddressStreetCityStateZipLicense Number:State:Date of Birth: / /Signature of Employee/Owner Operator/Applicant:Date:Revision: 001Date: 01/2020Author: Nicole O’Connell
7 Driver Qualification FileGENERAL CONSENT FOR LIMITED QUERIES OF THE FEDERAL MOTORCARRIER SAFETY ADMINISTRATION (FMCSA) DRUG AND ALCOHOLCLEARINGHOUSETHE UNDERSIGNED DOES HEREBY ACKNOWLEDGE AND CERTIFYAS FOLLOWS:I, ,(Print full legal Driver/Operator name as it appears on driver’s license)hereby provide consent to Russ Davis Wholesale to conduct a limited query of the FMCSACommercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whetherdrug or alcohol violation information about me exists in the Clearinghouse.I understand that I am consenting to an unlimited number of limited queries that will be conductedannually, at a minimum, starting at the date of this signed consent form until my date of Termination.I understand that if the limited query conducted by Russ Davis Wholesale indicates that drug oralcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose thatinformation to Russ Davis Wholesale without first obtaining additional specific consent from me. Fullquery consent can only be obtained through the Driver/Operator’s Clearinghouse account.I further understand that if I refuse to provide consent for Russ Davis Wholesale to conduct a limitedquery of the Clearinghouse, Russ Davis Wholesale must prohibit me from performing safetysensitive functions, including driving a commercial motor vehicle (over 26,000 lbs.), as required byFMCSA’s drug and alcohol program regulations.Driver/Operator License Number & State:Date of Birth: / /Signature of Driver/Operator:Date:Authorized Representative Name (print):Authorized Representative Signature:Date:Revision: 001Date: 01/2020Author: Nicole O’Connell
8 Personnel FileNotice to Drivers AndDriver’s Certification ofOther Compensated WorkNOTICE TO DRIVERS49 CFR Federal Motor Carrier Safety Regulations Section 395.2 defines ON DUTY TIME to include: Performing any other work in the capacity of, or in the employ or service of, a common,contract or private motor carrier; and / or Performing any compensated work for any non-motor carrier entity.Any work that meets one or both of these requirements MUST be reported to your supervisor so thatconsiderations may be made to avoid exceeding the Hours of Service limits. This is for the drivers ownsafety in attempt to avoid dispatching a fatigued driver.DRIVER’S CERTIFICATION OF OTHER COMPENSATED WORKI hereby certify that I have read the NOTICE TO DRIVERS that appears above, and understand that anytime I spend performing work that qualifies under either or both of the above definitions must be reportedas ON DUTY TIME under the Hours of Service Regulations.I further certify that: (check appropriate box)Currently I AM NOT performing any work in the capacity of, or in the employ or service of, acommon, contract or private motor carrier and / or performing any compensated work forany non-motor carrier entity. I will immediately notify my company if the circ
Driver Onboarding Checklist (Checklist to be filed in Personnel File) 10/20/2020 Initial Driver Qualification File Documents - All Forms Sent to Human Resources Retention Form # Description Responsible Completed Life of 1employment 3 years after termination 1.1 Driver Application for Employment
