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:9652Effective January 6, 2023: Motor carriers will no longer need to contact a CDL driver’s former employers to inquire about FMCSA drug or alcohol testing violations. Motor carriers must run a Drug & Alcohol Clearinghouse query instead. Former employers must still be contacted for employment verification and the driver’s crash history. Therefore, drug/alcohol questions have been removed from the Safety Performance History Records Request form (No. 9620 or 9652). The revised Previous Employer Alcohol & Drug Test Information form (No. 6827 or 6828) should be used to obtain information about an applicant’s DOT drug or alcohol violations that occurred under a non-FMCSA agency (FAA, FTA, FRA, PHMSA, etc.).
- 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