"*" indicates required fields Step 1 of 2 50% DRIVER STATEMENT OF ON-DUTY HOURS INSTRUCTIONS: Motor carriers when using a driver for them intermittently shall obtain from the driver a signed statement giving the total time on-duty during the immediately preceding 7 days and time at which such driver was last relieved from duty prior to beginning work for such carrier. Rule 395.8(j)(2) Federal Motor Carrier Safety Regulations. NOTE: Hours for any compensated work during the preceding 7 days, including work for a non-motor carrier entity, must be recorded on this form.Today's Date MM slash DD slash YYYY HiddenCarrier ID SlipSeat ID HiddenRole HiddenDriver Email HiddenCarrier Email Driver Name First Last CDL Day 1 (Yesterday) MM slash DD slash YYYY Hours Worked*Day 2 MM slash DD slash YYYY Hours Worked*Day 3 MM slash DD slash YYYY Hours Worked*Day 4 MM slash DD slash YYYY Hours Worked*Day 5 MM slash DD slash YYYY Hours Worked*Day 6 MM slash DD slash YYYY Hours Worked*Day 7 MM slash DD slash YYYY Hours Worked*Total HoursI was last relieved from work at:Time* Hours : Minutes AM PM AM/PM Date MM slash DD slash YYYY I hereby certify that the information given above is correct to the best of my knowledge and belief.Driver Signature Reset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY DRIVER CERTIFICATION FOR OTHER COMPENSATED WORK INSTRUCTIONS: when employed by a motor carrier, a driver must report to the carrier all on-duty time including time working for other employers. The definition of on-duty time found in Section 395.2 paragraphs (8) and (9) of the Federal Motor Carrier Safety Regulations, includes time performing any other work in the capacity of, or in the employ or service of, a common, contract or private motor carrier, also performing any compensated work for any non-motor carrier entity.Are you currently working for another employer?* Yes No At this time, do you intend to work for another employer while still employed by this Company?* Yes No Certification* I hereby certify that the information given above is true and I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity.I hereby certify that the information given above is true and I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity. Carrier SectionEMPLOYMENT CHECKLIST FOR MULTIPLE-EMPLOYER DRIVER The qualification file for a multiple-employer driver employed under the rules in Section 391.63 must include the following documents and must be retained for 3 years after the person's employment by the motor carrier ceases: 1. Medical Examiner's Certificate - The medical examiner's certificate of his or her physical qualification to drive a motor vehicle or a legible photocopy of the certificate pursuant to Section 391.43. 2. Certificate of Driver's Road Test - The certificate of driver's road test issued to the driver pursuant to Section 391.31(e), or a copy of the CDL license or certificate which the motor carrier accepted as equivalent to the driver's road test pursuant to Section 391.33. 3. Identification Information - Before allowing him or her to drive a commercial motor vehicle (CMV), the motor carrier must obtain the driver's name and Social Security number, and the identification number, type, and issuing state of his or her CMV operator's license. ALCOHOL AND CONTROLLED SUBSTANCE TESTING A motor carrier must ensure that a multiple-employer driver is currently participating in a drug and alcohol testing program as required by Part 382 of the Federal Motor Carrier Safety Regulations, including the following: - The driver has been given a pre-employment drug test OR the records listed in Section 382.301(c) have been obtained. These records must be re-obtained at least every 6 months for any driver used more than once per year. - The driver is enrolled in our drug and alcohol testing program. Information regarding individual results of alcohol and controlled substance testing must be maintained in a secure location with controlled access.Carrier Signature Reset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
