Emergency Contact Information
Previous Three Years Residency
Section 383.21 FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license”. I certify that I do not have more than one motor vehicle license, the information for which is listed below.
Certification of Compliance with Driver's License Requirements
MOTOR CARRIER INSTRUCTIONS: The requirements in part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.
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The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.
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DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1, 1987. They are as follows:
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- You, as a commercial vehicle driver, may not possess more than one license
- If you currently have more than one license, you should keep the license from your state of residence, and return the additional licenses to the states that issued them. Destroying a license does not close the record in the state that issued it; you must notify the state. If a multiple license has been lost, stolen, or destroyed, you should close your record by notifying the state of issuance that you no longer want to be licensed by that state.
- Sections 392.42 and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer THE NEXT BUSINESS DAY of any revocation or suspension of your driver's license. In addition, section 383.31 requires that at any time you violate a state or local traffic law (other than parking) you must report it to your employing motor carrier and the state that issued your license within 30 days.
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DRIVER CERTIFICATION: I certify that I have read and understand the above requirements. The following license is the only one I will possess:
To be Read and Signed by Applicant
I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries requiring medical history will be made only if and after a conditional offer of employment has been extended). I hereby release schools, employers, healthcare providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.
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In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge from the company. I understand that I am required to abide by all rules and regulations of the Company.
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"I understand that information I provide regarding current and/or previous 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(d) and (e). I understand that I have the right to:
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- Review information provided by current/previous employers
- Have errors in the information be corrected by previous employers and for those previous employers to re-send 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 have completed this application, and that all entries on it and information in it are true and completed to the best of my knowledge.
