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J. J. Keller protects people and the businesses they run. You can trust our expertise across a wide range of subjects relating to labor, transportation, environmental, and worker safety. Our deep knowledge of federal and state agencies is built on a strong foundation of more than 100 editors and consultants and 70+ years of regulatory compliance experience.

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J. J. Keller protects people and the businesses they run. You can trust our expertise across a wide range of subjects relating to labor, transportation, environmental, and worker safety. Our deep knowledge of federal and state agencies is built on a strong foundation of more than 100 editors and consultants and 70+ years of regulatory compliance experience.

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Safety Performance History Records Request - Padded Format, 8-1/2" W x 11" L

Includes 50 forms (8-1/2" x 11") per pad.

Product Code:9652
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  • Use to help satisfy 49 CFR §391.23(a)(2), (d), and (e), which require the prospective employer to obtain driver identification, employment and accident history from a driver/applicant's previous employers
  • Covers driver/applicant's authorization to release information; employment verification and accident information
  • Padded format, 50 sheets per pad
  • Measures 8-1/2" W x 11" L

Interested in a license to use this form electronically?
For a quote to use this form electronically, such as on your company intranet, or with form-fillable fields, contact us at customsolutions@jjkeller.com or 1-800-327-6868 to discuss. Learn more.

Number of Plies: 1

Compliance Topic: Injury & Illness Recordkeeping, Driver Qualification & Hiring, DOT Drug & Alcohol Management

Size: 8.5" x 11"

Format: Sheet

Need to Purchase a Case?: 50 per case

Industry: Human Resources, Transportation

Average Rating: 5.0

BVNumberOfReviews: 3

UNSPSC Number: Examination booklets or forms - 14111533

Country Of Origin: USA