Pre-Employment CDL Driver Qualification File Checklist

1 Pre-Employment CDL Driver Qualification File Checklist This document can serve as a hiring Checklist to help the municipality make sure that it is complying with the Federal CDL hiring requirements. Each Driver 's Qualification file (DQF) must be retained for as long as a Driver is employed and for three years thereafter (c). The DQF must include documents from ongoing recordkeeping (see the Recordkeeping section for more details) as well as the Pre-Employment documents listed below: A completed CDL job application for each CMV Driver , in accordance with (required). This is not a standard job application. A sample application is provided in the later pages of this section or by contacting VLCT PACIF. The Driver Qualification file elements from previous employers in accordance with (required).

2 This includes employment record, accident history, and alcohol and drug testing records for the preceding 3 years from any DOT regulated employer. If the records are not obtained from prior employer(s), evidence of the attempt must be retained. All above documents must be maintained per An employment history/ drug & alcohol testing request form is provided in the later pages of this section or by contacting VLCT PACIF. NEW! Beginning on January 6, 2020, a full Pre-Employment query of the FMCSA drug & Alcohol Clearinghouse must be completed in accordance with (a)(1) (required). Basically, employers are prohibited from hiring a Driver who has a drug and alcohol violation, except where the Clearinghouse query demonstrates successful completion of substance abuse treatment, return-to-duty testing, and follow-up testing (see (d) for more information).

3 The prospective Driver must give specific consent for a full query and will need their own Clearinghouse account to do so. Clearinghouse link: Pre-Employment motor vehicle records check results for prior 3 years from each state in which the Driver has operated a commercial motor vehicle in accordance with by (a)(1) (required). This may require contacting states other than Vermont. A copy of the Vermont DMV motor vehicle records request form is provided in the later pages of this section and is also available on the Vermont DMV website (note that the document is 2 pages). Acceptable Pre-Employment drug test results or exemption form filled out by previous employer (required). NOTE: VLCT recommends each new employee undergo Pre-Employment drug testing and that the municipality not utilize the exemption.

4 Contact Occupational drug Testing to schedule the Pre-Employment test. The certificate of Driver 's road test issued to the Driver , or a copy of the commercial Driver license in accordance with (e) (required). VLCT/PACIF recommends that an actual road test be given to potential new hires. (OPTIONAL) The DOT certified medical examiner's certificate of his/her physical Qualification to drive a commercial motor vehicle as required by (f) or a legible photographic copy of the certificate. Note: this is a "best practice" recommendation, as municipalities are typically exempt from this requirement. We suggest that the municipality establish a policy requiring CDL drivers to maintain their medical certification card. This best practice should start at hire and continue though the duration of employment.

5 NOTES. Driver records must be maintained in a secure manner, similar to personnel records-but should be separate. Additional information can be obtained from VLCT loss control staff and at: security/ In the event that Occupational drug Testing is unable to meet an urgent schedule for hiring a new CDL Driver , they will direct you to the nearest certified clinic so that the Pre-Employment testing can be performed within a reasonable timeframe. Pre-Employment - Driver Qualification File Checklist COMMERCIAL MOTOR VEHICLE OPERATOR. APPLICATION FOR EMPLOYMENT. COMPANY _____ STREET ADDRESS _____. CITY, STATE AND ZIP CODE _____. NAME _____. (FIRST) (MIDDLE) (Maiden Name, if any) (LAST). ADDRESS _____ HOW LONG? _____. (STREET) (CITY) (STATE & ZIP CODE). DATE OF BIRTH _____ SOCIAL SECURITY NO. _____ HIRE DATE _____.

6 TELEPHONE NUMBER _____ E-MAIL ADDRESS _____. PREVIOUS THREE YEARS RESIDENCY. _____ # YEARS _____. (STREET) (CITY) (STATE & ZIP CODE). _____ # YEARS _____. (STREET) (CITY) (STATE & ZIP CODE). _____ # YEARS _____. (STREET) (CITY) (STATE & ZIP CODE). (ATTACH SHEET IF MORE SPACE IS NEEDED). LICENSE INFORMATION. Section 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. STATE LICENSE NO. TYPE EXPIRATION DATE. DRIVING EXPERIENCE. CLASS OF TYPE OF EQUIPMENT (VAN, DATES APPROX. NO. OF. EQUIPMENT TANK, FLAT, ETC.) FROM TO MILES (TOTAL). STRAIGHT TRUCK. TRACTOR AND SEMI-TRAILER. TRACTOR TWO TRAILERS. OTHER. ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED).

7 DATES NATURE OF ACCIDENT NUMBER NUMBER CHEMICAL SPILLS. (HEAD-ON, REAR-END, UPSET, ETC.) FATALITIES INJURIES. YES NO . YES NO . YES NO . TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS). DATE CONVICTED VIOLATION STATE OF VIOLATION PENALTY. (month/year) LOCATION (forfeited bond, collateral and/or points). (ATTACH SHEET IF MORE SPACE IS NEEDED). A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? YES _____ NO _____. If yes, explain _____. B. Has any license, permit or privilege ever been suspended or revoked? YES _____ NO _____. If yes, explain _____. EMPLOYMENT RECORD. (ATTACH SHEET IF MORE SPACE IS NEEDED). Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years.

8 You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record). Must list the complete mailing address: street number and name, city, state and zip code. LAST EMPLOYER: NAME _____. ADDRESS _____ PHONE _____. POSITION HELD _____ FROM _____ TO _____. REASONS FOR LEAVING _____. ANY GAPS IN EMPLOYMENT AND/OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH/YEAR) AND REASON. _____. Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? Yes No . Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?

9 Yes No . SECOND LAST EMPLOYER: NAME _____. ADDRESS _____ PHONE _____. POSITION HELD _____ FROM _____ TO _____. REASONS FOR LEAVING _____. ANY GAPS IN EMPLOYMENT AND/OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH/YEAR) AND REASON. _____. Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? Yes No . Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40? Yes No . THIRD LAST EMPLOYER: NAME _____. ADDRESS _____ PHONE _____. POSITION HELD _____ FROM _____ TO _____. REASONS FOR LEAVING _____. ANY GAPS IN EMPLOYMENT AND/OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH/YEAR) AND REASON.

10 _____. Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? Yes No . Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40? Yes No . 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 regarding medical history will be made only if and after a conditional offer of employment has been extended). I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.