Transcription of SELF-CERTIFICATION FORM
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SELF-CERTIFICATION FORM
If you are not currently working as a commercial driver but would like to keep your CDL, you must submit the below certification. If you select either the EA or EI box, you will be able to keep your CDL without submitting a current medical card. If/When you return to driving a commercial vehicle and you need to carry a medical card, you must resubmit a DL-11CD, SELF-CERTIFICATION Form, along with a copy of your valid medical card. NOTE: You must be at least 21 years of age or older to operate a commercial vehicle in non-excepted interstate transportation. A K restriction will be added to your license for any intra-state driving type. Please check only one of the following SELF-CERTIFICATION driving types that apply to you. I certify that I drive or expect to drive a commercial vehicle in:NI I drive a commercial vehicle both in and outside the boundaries of Pennsylvania, and I currently carry a Medical Examiner s Certificate (DOT PHYSICAL CARD). Please enlarge your Medical Examiner s Certificate to 5 inches by 7 inches and make sure that all ofthe health care provider information is complete and I drive a commercial vehicle only within the boundaries of Pennsylvania, and I currently carry a Medical Examiner s Certificate (DOT PHYSICAL CARD).
• Drivers who are employed by the Federal government, a state, or any political subdivision of a state who engage in interstate commerce. • School bus drivers employed by a school district who transport students for any purpose other than home to …
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