The attached documents are provided to you to illustrate compliance with the USA laws that came into effect October 29, 2004 in the Federal Motor Carrier Safety Regulations (FMCSR).

This packet is not meant as an all-inclusive list of items; consult Federal Motor Carrier Safety Regulations (FMCSRs) Parts 40,382 and 391.

DRIVER HIRING & QUALIFICATION RECORDS CHECKLIST: (Revised 6/11) Form is used to document driverfile requirements per FMCSR 391 and renewal dates for these items.
APPLICATION FOR QUALIFICATION:(Revised 2011/06) by FMCSR 391.21. This application is suitable for independent owner/operators or company employees/drivers. NOW includes Driver’s Rights under 391.23.
REQUEST FOR DRIVER’S SAFETY PERFORMANCE HISTORY:(NEW 9/04) As by FMCSR 391.21 for past employment investigation.
FOURTEEN-DAY PRIOR LOG FORM:FMCSR 395.3. requirement is for previous 7 days, however, best practice in Canada is for previous 14 days
DRIVER PERFORMANCE EVALUATION {Road Test} (Revised 9/04) Should be used to summarize the evaluator’s thoughts on driver performance, including skills performed particularly well, those needing improvement and why. Includes:
CERTIFICATION OF ROAD TEST As per FMCSR Subpart D 391.31.
VIOLATION AND ANNUAL REVIEW RECORD: Allows review of driver’s record as by FMCSR 391.25 and 391.27.
DRIVER “INVESTIGATION HISTORY” FILE CHECKLIST (NEW 9/04) FMCSR requires this form to be filed in a secure location, with limited access.

The following documents should be placed in Personneland/or Confidential File.

DRIVER APPLICANT AND ALCOHOL PRE-EMPLOYMENT STATEMENT:(NEW) Form used to documentan applicant applying for a safety sensitive function, as per CFR 40.25(j).
CONTROLLED SUBSTANCE & ALCOHOL TESTING INFORMATION ACKNOWLEGEMENT/ CONSENT FORM:(NEW 9/04) As by FMCSR 382.301. [Page 1, drug & alcohol information, needs to be kept in Confidential File.]

DRIVER HIRING & QUALIFICATION RECORDS CHECKLIST
DRIVER’S RIGHTS PERTAINING TO RELEASE OF DRIVER INFORMATION UNDER REGULATION 391.23
APPLICATION FOR QUALIFICATION
DRIVER APPLICANT DRUG AND ALCOHOL
PRE-EMPLOYMENT STATEMENT
CONTROLLED SUBSTANCE & ALCOHOL TESTING INFORMATION ACKNOWLEDGEMENT/CONSENT FORM
DRIVER "INVESTIGATION HISTORY" FILE CHECKLIST
Request for Driver’s Safety Performance History & Information from DOT Regulated Previous Employer(s)
FOURTEEN-DAY PRIOR LOG FORM
DRIVER PERFORMANCE EVALUATION
Driver Performance Evaluation
CERTIFICATION OF ROAD TEST
VIOLATION AND ANNUAL REVIEW RECORD
EMPLOYEE INFORMATION FORM

DRIVER HIRING & QUALIFICATION RECORDS CHECKLIST

DRIVER’S NAME

DRIVER’S EMAIL (Copy of this form will be sent to this email)

DATE OF HIRE

DRIVER’S RIGHTS PERTAINING TO RELEASE OF DRIVER INFORMATION UNDER REGULATION 391.23

Motor carriers have the responsibility to make the following investigations and inquiries with respect to each driver employed, other than a person who has been a regularly employed driver of the motor carrier for a continuous period, which began before January 1, 1971.

(1) An inquiry into the driver’s driving record during the preceding three years to the appropriate agency of every State in which the driver held a motor vehicle operator’s license or permit during those three years; and(2) An investigation of the driver’s employment record during the preceding three years.
A copy of the driver record(s) obtained in response to the inquiry or inquiries to each State driver record agency, asrequired. This must be placed in the Driver Qualification File within 30 days of the date the driver’s employment begins andbe retained in compliance with 391.51.
Replies to the investigations of the driver’s safety performance history must be placed in the Driver InvestigationHistory File within 30 days of the date the driver’s employment begins. This is effective as of October 30, 2004.
Prospective motor carrier must investigate the information from all previous employers of the applicant thatemployed the driver to operate a CMV within the previous three years. This information must cover general driver identification and employment verification information, data elements as specified in 390.15 for any accidents involving the driver that occurred in the three-year period preceding the date of the employment application, and any accidents the previous employer may wish to provide.
Prospective motor carrier must investigate the information from all previous DOT regulated employers that employed the driver within the previous three years from the date of the employment application in a safety-sensitive function that alcohol and controlled substance testing specified by 49 CFR Part 40.

Drivers have the following rights:

The right to review information provided by previous employers;
The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer; and
The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and thedriver cannot agree on the accuracy of the information.

Drivers who wish to review previous employer-provided investigative information must submit a written request to the prospective employer when applying or as late as 30 days after employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five business days of receiving the written request. If the driver has not arranged to pick up or receive the requested records within 30 days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records.

Drivers wishing to request correction of erroneous information in records must send the request for the correction to the previous employer that provided the records. After October 29, 2004, the previous employer must either correct and forward the information to the prospective motor carrier employer or notify the driver within 15 days of receiving the driver’s request to correct the data that it does not agree to correct the data. Drivers wishing to rebut information in records must send the rebuttal to the previous employer with instruction to include the rebuttal in the driver’s Safety Performance History.

I acknowledge that I have read and understand the contents of this document.

First Name Last Name

DATE

APPLICATION FOR QUALIFICATION

Company Name

Address

City Province Postal Code

The purpose of this application is to determine whether or not the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and the Company named above.

Instructions: 1. Please print clearly.
2. Complete all sections. If the answer to any question is “No” or “None,” do not leave the item blank, but write "No" or "None."

SECTION A - APPLICANT INFORMATION

Name (First, Middle, Last) Date of birth Telephone number

Position applying for (check one) Driver Contractor Contractor’s Driver Other (please specify) Alternative Telephone number

Residence history for the past three years, beginning with your current address.

Current Address (no., street) From

City Province Postal code To

Address (no., street) From

City Province Postal code To

Address (no., street) From

City Province Postal code To

Address (no., street) From

City Province Postal code To

Have you worked for this company before? Yes No

If yes, when? From To

Reason for leaving?

Please select the highest grade level completed Grade school College/University Post-graduate

SECTION B– EMPLOYMENT HISTORY

Please provide a complete record of all employment (starting with the current or most recent) for the past three years, including any unemployment or self-employment. Please also provide all commercial driving experience for the past ten years.

Company Name Position held Telephone number

Address (no., street) From

City Province Postal code To

Reason for leaving?

Were you subject to the FMCSRs* while employed here? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes No

Company Name Position held Telephone number

Address (no., street) From

City Province Postal code To

Reason for leaving?

Were you subject to the FMCSRs* while employed here? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?Yes No

Company Name Position held Telephone number

Address (no., street) From

City Province Postal code To

Reason for leaving?

Were you subject to the FMCSRs* while employed here? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?Yes No

Company Name Position held Telephone number

Address (no., street) From

City Province Postal code To

Reason for leaving?

Were you subject to the FMCSRs* while employed here? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?Yes No

*The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone who operates a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) has a GVWR or weighs 10,001 pounds or more; (2) is designed or used to transport nine or more passengers; or (3) is of any size, used to transport hazardous materials in a quantity requiring placarding.

SECTION C – DRIVING HISTORY/EXPERIENCE

Driving Experience	Dates		Approximate Miles
Driving Experience	From	To	Approximate Miles
Straight Truck
Tractor-trailer
LCV's
Other: (specify)

List provinces and states operated in for the last five years.

List special courses/training completed (PTD/DDC, Dangerous Goods, etc).

List any Safe Driving Awards you hold and from whom.

Collision record for the past three years (attach an additional sheet, if)

Date of collision	Nature of Collision	Location	Number of fatalities	Number of injured people

Traffic convictions and forfeitures for the past three years (other than parking violations)

Date	Location	Offence	Penalty

Driver’s License (List each driver’s license held in the past three years.)

Province	License number	Type	Endorsements	Expiration date

Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No

If yes, please provide details.

Has any license, permit or privilege ever been suspended or revoked? Yes No

If yes, please provide details.

Personal references – List three persons for references, other than family members, who have knowledge of your safety habits.

Name	Address	Telephone number

To Be Read and Signed by Applicant

This certifies that I completed this application form and that all entries on it and information in it are true and complete to the best of my knowledge. It is agreed and understood that any misrepresentation given on this application or interview(s) shall be considered an act of dishonesty and may result in a discharge.

It is agreed and understood that the motor carrier or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information.

I agree to furnish such additional information and complete such examinations as may be to complete my application file.

It is agreed and understood that this Application for Qualification in no way obligates the motor carrier to employ or hire the applicant.

It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse.

I understand that from time to time the company will furnish my personal information as necessary to third parties such as insurance companies and brokers. The company agrees to collect, use and disclose such information only in a manner that a reasonable person would consider appropriate in the circumstances, and that would be in compliance with the Protection of Personal Information and Electronic Documents Act (PIPEDA).The company further agrees to safeguard the security of such information in a manner appropriate to the sensitivity of such information, and in compliance with PIPEDA.

I agree to supply the following information as part of this application

Driver’s MVR Abstract (current to the past 30 days)
Driver’s CVOR Abstract (Ontario only, current to the past 30 days)
Criminal Record Search (current to the past 90 days)

Applicant First Name Applicant Last Name

DATE

Remarks (For office use only)

DRIVER APPLICANT DRUG AND ALCOHOL
PRE-EMPLOYMENT STATEMENT

CFR Part 40.25(j) requires the employer to ask any applicant, whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol rules during the past two years. If the potential employee admits that he or she had a positive test or refusal to test, we must not use the employee to perform safety-sensitive function, until and unless, the potential employee provides documentation of successful completion of the return-to-duty process.
(See Section 40.25(b)(5) and (e).

As an applicant, applying to perform safety sensitive functions for our company, you are by CFR Part 40.25(j) to respond to the following questions.

1) Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years? Yes No

2) If you answered yes, to the above question, can you provide proof that you have successfully completed the DOT return-to-duty requirements?Yes No

My signature below certifies that the information provided is true and correct.

First Name Last Name

DATE

CONTROLLED SUBSTANCE & ALCOHOL TESTING INFORMATION ACKNOWLEDGEMENT/CONSENT FORM

As a condition of employment with (Motor Carrier), Commercial Motor Vehicle (CMV) Driver Applicants must submit to a pre-employment controlled substances test as by the Federal Motor Carrier Safety Regulations (FMCSR) Section 382.301. A motor carrier must receive verified negative test results for the applicant driver for the applicant to be eligible for employment.

If you are hired, you will be subject to laws requiring additional controlled substances and alcohol testing on you under numerous situations including, but not limited to, the following:

Post-Accident – Section 382.303, Random– Section 382.305, Reasonable Suspicion – Section 382.307, Return to Duty – Section 382.309, Follow-up – Section 382.311

A driver, who tests positive to a controlled substance and/or alcohol test, will be immediately removed from a safety-sensitive position as by Part 382 of the FMCSR. Federal law prohibits a Driver from returning to a safety-sensitive position for any motor carrier until and unless the Driver completes the Substance Abuse Professionals (SAP) evaluation, referral and educational/treatment process, as described in FMCSR Part 40, Subpart O.

The following is a referral list of Substance Abuse Professionals: (to be completed by Carrier)

Name	Address	Telephone number

All controlled substances and alcohol testing will be conducted in accordance with Parts 40 and 382 of the FMCSR.

I have read the above controlled substances and alcohol testing requirements and understand them. I acknowledge receipt of the referral list of Substance Abuse Professionals.

Applicant First Name Applicant Last Name

DATE

Employer First Name Employer Last Name

DATE

Original to be retained on file - Copy to Driver Applicant

DRIVER "INVESTIGATION HISTORY" FILE CHECKLIST

The Federal Motor Carrier Safety Regulations require motor carriers to maintain the Driver Investigation History File in a secure location with access to the files limited to those individuals with a need to know basis.

Driver’s Name

Request for Driver’s Safety Performance History & Information from DOT Regulated Previous Employer(s)

NOTES:

If this information is not available from the previous employer, you as a prospective employer must get this information from the Driver/Applicant.
Drug and Alcohol information must be kept in a separate Personnel and/or Confidential file.

Hiring company to complete this section

Carrier name Contact person

Address Telephone number

City Province Postal code Confidential fax number

Driver to complete this section

As a Commercial Motor Vehicle (CMV) Driver, I understand that per the Federal Motor Carrier Safety Regulations (FMCSRs) Part 391.21, the following information will be requested from all previous Employers for which I operated a CMV, subject to the FMCSR Parts 390 and/or 40, 382 & 383, within the past three years, from date shown below. I also acknowledge that this information will be used in determining my eligibility to be hired, that I have the right to review this information and rebut any errors in these statements from my prior employers, as described in the FMCSR Part 391.23.

I , hereby authorize this Company to release all records of employment, including assessments of my job performance, ability and fitness (including dates of any and all alcohol or drug tests, those confirmed results and/or my refusal to submit to any alcohol or drug tests and any rehabilitation completion under direction of (SAP/MRO) to each and every company (or their authorized agents) which may request such information in connection with my application for employment with said company. I hereby release this company, and its employees, officers, directors, and agents from any and all liability of any type as a result of providing information to the above-mentioned person and/or company.

Previous Employer Contact person

Address Telephone number

City Province Postal code Fax number

Dates of employment: From Dates of employment: To

ID number Date of birth Date

First Name Last Name

DOT Regulated past employer to complete the following sections

SECTION I – DRUG & ALCOHOL INFORMATION

Please provide the following Drug and Alcohol information as by FMCSR Part 391.23 & 40.25.

If no Drug and Alcohol information is available on above named applicant check here.

SECTION II – ACCIDENT INFORMATION

Please provide the following information as by 391.23(d) (1) (2) on any accidents, as defined by 390.5 and/or from your Accident Register (FMCSR 391.15) which the above named Driver/Applicant was involved within the past three years while under your employment. Previous employers may include additional detailed information on minor accidents/incidents at their discretion.

If no Drug and Alcohol information is available on above named applicant check here.

Date	Location City/town, Province/State	Any Vehicles Towed?	HazMat Spill?	Number of fatalities?	Number of injured?

SECTION III – WORK HISTORY INFORMATION

Position held (please check all that apply): Driver Contractor Contractor’s Driver Other (please specify)

Dates of employment: From Dates of employment: To

If employed as a Driver, what type of equipment did he/she operate? Straight Trucks Tractor/Trailer Doubles Triples Other (please specify)

Type of Trailer(s) pulled

General area traveled Commodities transported

While under your employment was he/she:
a. Bonded: Yes No b. Convicted of any traffic violations: Yes No

If yes, please list all, including date and type:

c. License(s) suspended, revoked or denied: Yes No

If yes, please explain:

Reason for leaving Would you re-employ this person: Yes No Upon Review
Please explain:

Additional comments

Title Date

First Name Last Name

Please remember to retain a copy for your records. Your timely response is appreciated.

FOURTEEN-DAY PRIOR LOG FORM

(Data sheet for new, casual, or temporary drivers)

NAME ID #

ADDRESS

PHONE DRIVER’S LICENSE # Province

Instructions:At the time of initial employment as a driver, or when being employed occasionally, the regulations of the Department of Transportation [Section 395.8 (j)(2)] require the motor carrier to obtain from you a signed statement giving the total time on duty during the immediately preceding 7 days and the time at which you were last relieved from duty prior to beginning work for the motor carrier. In the spaces below, show the number of hours worked (on duty) in each of the last 7 days. For Canadian drivers please enter each of the last fourteen days.

Day	1	2	3	4	5	6	7	Total
Date
On Duty Hours
Day	8	9	10	11	12	13	14	Total
Date
On Duty Hours

I hereby certify that the information given above is correct to the best of my knowledge and belief, and that I was last relieved from work at:(Time Day) on (month-year)

First Name Last Name

Witness (Company Representative) Date #

DRIVER PERFORMANCE EVALUATION

Instructions to Examiner: Check (√) items that the driver performs satisfactorily use “X” where performance is unsatisfactory. Any item notevaluated leave blank.

Driver’s Name Address

License No. Prov. Class

Equipment Driven: Truck/Tractor Trailer(s)

Date of Test Length of Test (miles) From To

Start Time Finish Time Weather Conditions

PART 1------ PRE-TRIP INSPECTION AND EMERGENCY EQUIPMENT

Checks general condition when approaching unit(s) Checks fuel, oil, water and for excessive oil on engine Checks around unit - tires, lights, trailer hook-up, brake and electrical lines, doors, and inspects for body damage Tests steering, brake action, tractor protection valve, and parking brake Checks horn, windshield wipers, mirrors, emergency equipment; reflectors, flares, fuses, tire chains (if necessary), fire extinguisher, registration/licensing Cleans windshield, windows, mirrors, lights, and reflectors (No standing on tires) Utilizes three point entry/exit Proper Non-Slip Footwear Section Score

PART 2------PLACING VEHICLE IN MOTION AND USE OF CONTROLS

A. ENGINE

Places transmission in neutral before starting engine Properly starts engine without difficulty and checks instruments for normal readings Checks instruments at regular intervals Maintains proper engine RPM while driving

B. BRAKES

Knows proper use of and checks tractor protection valve Tests service brakes Tests parking brake before driving Builds full pressure in air tanks before starting

C. CLUTCH AND TRANSMISSION

Starts unit moving smoothly Selects proper gears Uses clutch properly

D. LIGHTS (If conducting driving test at night)

Adjusts speed for range of headlights
Dims lights when approaching another vehicle or necessary following other traffic Section Score

PART 3------COUPLING AND UNCOUPLING

Connects glad hands to trailer to apply trailer brakes before coupling Connects glad hands and light line properly Couples without difficulty Raises landing gear fully after coupling Visually checks king pin assembly to be certain of proper coupling Checks coupling by applying hand value or tractor- protection valve and gently applying pressure by trying to pull away from trailer Assures himself/herself that surface will support trailer before uncoupling Properly engages or disengages fifth wheel Proper body position while pulling fifth wheel latch Proper body position while operating dolly crank Utilizes three point entry/exit Section Score

PART 4------BACKING AND PARKING

A. BACKING

Gets out and checks area before backing Understands and utilizes mirrors properly Signals when backing (if appropriate) Avoids backing from blind side Utilizes three point entry/exit

B. PARKING (CITY)

Parks without hitting any other vehicles or stationary objects Parks correct distance from curb Secures unit properly - sets parkingbrake, transmission in correct gear, shuts offengine, blocks wheels (when necessary) Carefully enters traffic from parked position

C. CLUTCH AND TRANSMISSION

Starts unit moving smoothly Selects proper gears Uses clutch properly

D. PARKING (ROAD)

Parks off pavement Uses emergency warning signal or devices when necessary Secures unit properly Parks legally Section Score

PART 5------SLOWING AND STOPPING

Uses clutch and gears properly Gears down properly before descending hills Starts without rolling back Tests brakes at top of hills Uses brakes properly on grades Makes proper use of mirrors Plans stop far enough in advance to avoid hard braking Stops clear of crosswalks Section Score

PART 6------OPERATING IN TRAFFIC, PASSING AND TURNING

A. TURNING

Signals intention to turn well in advance Gets into proper lane well in advance of turn Checks traffic conditions and turns only when intersection is clear Restricts traffic from passing on right when preparing to complete right hand turn Completes turn promptly and safely and does not impede other traffic Eliminates right-turn squeeze

B. TRAFFIC SIGNS AND SIGNALS

Plans stop in advance and adjusts speed correctly Obeys all traffic signals Comes to a complete stop at all stop signs

C. INTERSECTIONS

Yields right of way Checks for cross traffic regardless of traffic controls Prepared to stop at all intersections

D. GRADE CROSSINGS

Stops at a minimum 15 feet but not more than 50 feet before crossing if stop is necessary Selects proper gear and does not shift gears while crossing Knows and understands FMCS rules governing grade crossings

E. PASSING

Allows sufficient space ahead for passing Passes only in safe locations Signals changing lanes before and after passing Warns driver ahead of his/her intention to pass Passes only when appropriate to avoid impeding other traffic Returns to right lane promptly but only when safe to do so

F. COURTESY AND SAFETY

Yields right of way Consistently strives to drive in a safe manner Allows faster traffic to pass Uses horn only when necessary Section Score

PART 7------LANE CHANGE

Demonstrates Lean-and-Look method Utilizes proper mirror(s) Restricts lane change near exit/entrance ramps Signals intention Section Score

PART 8------SAFE FOLLOWING DISTANCES

Explains safe following distance practice Explains 4-6 second rule Maintains adequate spacing with other vehicles Section Score

PART 9------SPEED

Observes speed limits Drives at speed consistent with ability Adjusts speed to weather, traffic conditions Slows down in advance of curves, intersections Maintains consistent speed when possible Section Score

PART 10------MISCELLANEOUS

A. GENERAL DRIVING ABILITY AND HABITS

Consistently alert and attentive Consistently aware of changing traffic conditions Anticipates problems Performs routine functions without taking eyes from road Checks instruments regularly while driving Personal appearance is professional Remains calm under pressure Use of seat belt

B. UTILIZES 3 POINT CONTACT RULE WHEN ENTERING/EXITING EQUIPMENT

C. DEMONSTRATES/DESCRIBES PERSONAL PROTECTIVE EQUIPMENT

Proper non-slip footwear PPE (if applicable)

D. DEMONSTRATES APPROPRIATE FREIGHT MOVEMENT

E. UNDERSTANDS/PERFORMS CARGO SECUREMENT

F. USE OF SPECIAL EQUIPMENT (hoses, tarps, emergency gear, etc.)

Section Score

Driver Performance Evaluation

REMARKS: Should be used to summarize the evaluator’s thoughts on driver performance, including skills performed particularly well, those needing improvement and why.

OVERALL SCORE

Part 1 Part 2 Part 3 Part 4 Part 5 Part 6 Part 7 Part 8 Part 9 Part 10

SCORING CRITERIA

1 - Lowest 2-Low 3 - Moderate 4-High 5 – Highest

TOTAL: ÷ 10 = Average Score

GENERAL PERFORMANCE: Satisfactory Needs Training

Performance judged less than satisfactory requires documentation of corrective action taken in the area provided below.

Corrective Action Taken

UNQUALIFIED

QUALIFIED FOR

Tractor-Semi-trailer Other Special Equipment

Examiner First Name Examiner Last Name

Date

Driver First Name Driver Last Name

Date

The Driver Performance Evaluation should ensure the driver has the skills necessary to indicate the carrier made a good hiring decision. It should also be used as a baseline of behavior that provides direction for future training activities, strengths (and where in the company those strengths apply), weaknesses, and a means for identifying potential interventions, corrective actions, etc. Additionally, the Driver Performance Evaluationshould be used to evaluate the performance of existing drivers when necessary, for example after receipt of a moving violation, involvement in a collision, or other indicators of deteriorating performance.

Management should set guidelines for the scoring criteria, and meet regularly with their trainers to make sure all scoring is done consistently. Define what the lowest acceptable score is to meet company qualifications.

Instructions

Ensure the evaluation is of sufficient length to properly evaluate driver skills – we suggest 1-2 hours per evaluation.
Be sure the driver has a valid license to operate the type of equipment to be driven.
Ensure the evaluation will be performed in the type of equipment for which the driver is applying.
If possible, trailers should be loaded, especially tanks.
Explain the evaluation objectives.
Give the driver an opportunity to ask questions before the start of the evaluation.
Provide necessary direction and instructions during the evaluation.
Conduct the evaluation over a well-planned course that includes the types of operating environment the driver mayfind themselves in – rail crossings, right and left turns, mountains, city, etc.
Non-driving duties should be carefully observed. Watch for body position and behaviors that indicate knowledge ofproper injury prevention activities.
Specific actions in each section of the evaluation should be marked with a checkmark (√) on those items that thedriver performs satisfactorily, use an “X” where the driver’s performance is unsatisfactory. Any item not evaluatedshould be left blank.
After each section is complete, evaluator should circle the appropriate section score, with a score of “1” being thelowest and a “5” the highest.
Once the evaluation is complete, complete any comments from the evaluator, tally the scores on the last page of theevaluation, and enter the average score. Identify areas for improvement and corrective action to be completed.
Complete final entries, have driver and evaluator sign and date evaluation form.
Give the driver a constructive review when the evaluation is completed.
Evaluation results should be kept on file for an applicant rejected for any reason.

Note: Additional evaluation and training may be necessary depending on type of equipment the driver will be driving. Longer Combination Vehicles (LCVs) require documentation of experience and training, and must be attested to by appropriate company officials.

CERTIFICATION OF ROAD TEST

Per FMCSR Subpart D – Tests Section 391.31 Road Test (g) A copy of the certificate by paragraph (e) of this section shall be given to the person who was examined. The motor carrier shall retain in the driver qualification file of the person who was examined – (1) The original of the signed road test form by paragraph (d) of this section; and (2) The original, or a copy of, the certificate by Paragraph (e)of this section.

Driver’s Name ID # Operator’s or Chauffeur’s License No. Prov. Type of Power Unit Type of Trailer (s) If passenger carrier, type of bus

This is to certify that 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 safety the type of commercial motor vehicle listed above.

First Name Last Name

VIOLATION AND ANNUAL REVIEW RECORD

Driver’s Name

I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months.

Certification of Violations

Date of	Offence	Location	Type of Vehicle Operated

If NO violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation to be listed during the past 12 months.

(Date of Certification)

Driver’s First Name Driver’s Last Name

Motor Carrier’s Name Motor Carrier’s Address

Reviewed By- First Name Reviewed By- Last Name

Print Name and Title

ANNUAL REVIEW AND EVALUATION OF DRIVER’S RECORD

In accordance with Section 391.25, Motor Carrier Safety Regulations, all information pertinent to the driver’s safety of operations, including the list of violations furnished by him in accordance with Section 391.27, has been reviewed for the past 12 months.

Action Taken

Motor Carrier’s Name Motor Carrier’s Address

Reviewed By- First Name Reviewed By- Last Name

Title Date

EMPLOYEE INFORMATION FORM

Note: This form is to be completed only after an offer of employment has been made.

Employee information

Employee name Date of Birth Social Insurance Number

Address (no., street)

City Province Postal Code

Telephone number Alternate telephone number

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)? Yes No

If yes, please provide details:

If you are applying for a position that requires you to drive a commercial truck in the USA, are you able to legally enter the United States of America? Yes No

The offer of employment is conditional upon satisfactory clearance to enter the United States of America.

Emergency Contact

Name Relation

Telephone number Alternate telephone number

Name Relation

Telephone number Alternate telephone number

Payroll authorization (if direct deposit is used)

I hereby authorize my net pay, as earned from time to time, to be deposited to my designated Bank and Account Number.

Account Number Chartered Bank

Address (no., street)

City Province Postal Code

First Name Last Name

DATE

	✓
1. Application for Qualification should be fully completed and signed by applicant – No gaps in employment history. a. Driver’s Rights (to be given to the applicant prior to driver application) b. Driver Applicant Drug and Alcohol Pre-employment Statement c. Controlled Substance and Alcohol Testing Information Acknowledgement/Consent form d. Request for Driver’s Safety Performance History
2. Motor Vehicle Record (MVR) Province: Date obtained: (All licenses held by the driver in the last 3 years must be investigated.)
3. Driver Performance Evaluation [Road Test] (Fully completed & signed by Examiner.)
4. Receipt For Issuance of FMCSR Book
5. Receipt for Driver’s Manual/Policies
6. Certificate for Completion of Orientation (if applicable)
7. Fourteen-Day Prior Hours Statement or Copies of Log Sheets (To be placed with log files.)
8. Copy Of Driver’s License a) Expiration date: b) Class: c) Endorsements
9. Annual Driver’s Certification of Violations & Annual Review of Driving Record (MVR) (Must be completed at least once every 12 months from the date of hire.)
10. Other documents:
11. Notify your Insurance Broker of hiring decision

FORM OR PROCESS	COMPLETED		Initials of Person verifying
FORM OR PROCESS	YES	NO	Initials of Person verifying
1. Written notification of driver’s due process rights signed by the driver.
2. Written consent form signed by the driver to obtain previous employment verifications, safety information, and alcohol & controlled substance history.
3. Past employment verifications. (At least the previous three-year period. Additional verifications are recommended.)
4. Documentation of good-faith efforts to obtain information.
5. Verification from previous employers of violations of alcohol and/or controlled substance prohibitions within the previous three-year period.
6. Signed PSP Consent Form
7. Verification of the driver’s failure to complete rehabilitation program, if.
8. Verification follow-up testing was completed after rehabilitation, if.
9. Verification of alcohol tests .04 or higher.
10. Verification of positive drug tests, if.
11. Verification of refusals to be tested.
12. Records of requests and responses to prospective employers.
13. Reports to the Federal Motor Carrier Safety Administration pertaining to previous employers failure to respond to requests for information.
14. Copies of responses to drivers about requests to correct information.

	YES	NO
Any alcohol test with a result of 0.04 or higher alcohol concentration?
Any verified positive drug test?
Any refusals to be tested (including verified adulterated or substituted drug test results?)
Any other violations of DOT agency drug & alcohol testing regulations (Part 382 or Part 40)?
If this Driver did successfully complete a SAP rehabilitation referral and remained in your employ, did he/she have any subsequent violations for; an Alcohol test result of 0.04 or greater, a verified positive drug test or a refusal to test (including a verified adulterated/substituted drug test result?)
If yes to any of the above questions, please provide documentation of successful completion of a SAP evaluation, prescribed treatment and return-to-duty requirements (including follow-up tests) if they remained in your employ.

DRIVER QUALIFICATION PACKET

DRIVER HIRING & QUALIFICATION RECORDS CHECKLIST

DRIVER’S RIGHTS PERTAINING TO RELEASE OF DRIVER INFORMATION UNDER REGULATION 391.23

APPLICATION FOR QUALIFICATION

SECTION A - APPLICANT INFORMATION

Residence history for the past three years, beginning with your current address.

SECTION B– EMPLOYMENT HISTORY

SECTION C – DRIVING HISTORY/EXPERIENCE

Collision record for the past three years (attach an additional sheet, if)

Traffic convictions and forfeitures for the past three years (other than parking violations)

Driver’s License (List each driver’s license held in the past three years.)

Personal references – List three persons for references, other than family members, who have knowledge of your safety habits.

To Be Read and Signed by Applicant

DRIVER APPLICANT DRUG AND ALCOHOLPRE-EMPLOYMENT STATEMENT

CONTROLLED SUBSTANCE & ALCOHOL TESTING INFORMATION ACKNOWLEDGEMENT/CONSENT FORM

DRIVER "INVESTIGATION HISTORY" FILE CHECKLIST

The Federal Motor Carrier Safety Regulations require motor carriers to maintain the Driver Investigation History File in a secure location with access to the files limited to those individuals with a need to know basis.

Request for Driver’s Safety Performance History & Information from DOT Regulated Previous Employer(s)

Hiring company to complete this section

Driver to complete this section

DOT Regulated past employer to complete the following sections

SECTION I – DRUG & ALCOHOL INFORMATION

SECTION II – ACCIDENT INFORMATION

SECTION III – WORK HISTORY INFORMATION

FOURTEEN-DAY PRIOR LOG FORM

(Data sheet for new, casual, or temporary drivers)

DRIVER PERFORMANCE EVALUATION

PART 1------ PRE-TRIP INSPECTION AND EMERGENCY EQUIPMENT

PART 2------PLACING VEHICLE IN MOTION AND USE OF CONTROLS

A. ENGINE

B. BRAKES

C. CLUTCH AND TRANSMISSION

D. LIGHTS (If conducting driving test at night)

PART 3------COUPLING AND UNCOUPLING

PART 4------BACKING AND PARKING

A. BACKING

B. PARKING (CITY)

C. CLUTCH AND TRANSMISSION

D. PARKING (ROAD)

PART 5------SLOWING AND STOPPING

PART 6------OPERATING IN TRAFFIC, PASSING AND TURNING

A. TURNING

B. TRAFFIC SIGNS AND SIGNALS

C. INTERSECTIONS

D. GRADE CROSSINGS

E. PASSING

F. COURTESY AND SAFETY

PART 7------LANE CHANGE

PART 8------SAFE FOLLOWING DISTANCES

PART 9------SPEED

PART 10------MISCELLANEOUS

A. GENERAL DRIVING ABILITY AND HABITS

B. UTILIZES 3 POINT CONTACT RULE WHEN ENTERING/EXITING EQUIPMENT

C. DEMONSTRATES/DESCRIBES PERSONAL PROTECTIVE EQUIPMENT

D. DEMONSTRATES APPROPRIATE FREIGHT MOVEMENT

E. UNDERSTANDS/PERFORMS CARGO SECUREMENT

F. USE OF SPECIAL EQUIPMENT (hoses, tarps, emergency gear, etc.)

Driver Performance Evaluation

OVERALL SCORE

SCORING CRITERIA

UNQUALIFIED

QUALIFIED FOR

Instructions

CERTIFICATION OF ROAD TEST

VIOLATION AND ANNUAL REVIEW RECORD

Certification of Violations

ANNUAL REVIEW AND EVALUATION OF DRIVER’S RECORD

EMPLOYEE INFORMATION FORM

Employee information

Emergency Contact

Payroll authorization (if direct deposit is used)

DRIVER APPLICANT DRUG AND ALCOHOL
PRE-EMPLOYMENT STATEMENT