Use J. J. Keller's Safety Performance History Records Request combination form 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, and alcohol & drug testing information from a driver/applicant's previous employers. This form covers:

• Driver/applicant's authorization to release information
• Employment verification and accident information (including date, location, injuries, fatalities, and hazardous material spill details)
• Alcohol and drug test information (including previous tests, refusals, and rehabilitation)

Safety Performance History Records Request forms are available in two convenient formats:
Padded format measures 8-1/2" x 11". Single sheet, 50 forms per pad. Sold per pad.
Snap-out format measures 8-1/2" x 11-3/4". 3-ply with carbon. Sold in multiples of 10.

To request alcohol & drug and/or accident information separately, consider the Previous Employer Alcohol & Drug Test Information, and the Request For Information From Previous Employer, forms.

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