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Medical Examination Certificate - LaminatedHelps you comply with 49 CFR §391.43 DOT medical card requirements.
(15)
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Medical Examination Certificate - SmallHelps you comply with 49 CFR §391.43 DOT medical card requirements.
(1)
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Medical Examination Report FormHelps you comply with 49 CFR §391.43 DOT medical card requirements.
(2)
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Overview
NOTICE: The latest Medical Examiner’s Certificates show an OMB expiration date of 11/30/2021 in the upper-right corner. On Dec. 4, 2018, the Federal Motor Carrier Safety Administration (FMCSA) informed us that there is no specific deadline when forms dated 8/31/2018 or 9/30/2019 can no longer be used, though they do “suggest” that the 2019 or 2021 versions be used in place of the 2018 version. The FMCSA also announced that it “is encouraging the State Driver's Licensing Agencies (SDLAs) to accept these forms with expiration dates of 08/31/2018, 09/30/2019, and 11/30/2021.” Therefore, all three versions remain acceptable but upgrading to the 2019 or 2021 versions is advised.
- Complete package of forms required by 49 CFR 391.51
- Includes folder pre-printed with file contents and instructions for each form
- Contains the following forms:
- (1) Driver Qualification File Contents Sheet – Bond (3694)
- (1) Checklist for Qualification of New Drivers – 2 Copy Bond (1 White/1 Canary) (*506541)
- (1) Driver's Application for Employment – Bond (691)
- (2) Request for Check of Driving Record – 2 Copy Bond (1 White/1 Canary) (*506540)
- (1) Medical Examination Report – Bond (47375)
- (1) Medical Examiner’s National Registry Verification – 2 Copy Bond (1 White/1 Canary) (27033)
- (1) Record of Road Test – 2 Copy Bond (1 White/1 Canary) (652)
- (1) Certification of Compliance with Driver License Requirements – 2 Copy Bond (1 White/1 Canary) (1617)
- (1) Driver Statement of On-Duty Hours-New Hire – 2 Copy Bond (1 White/1 Canary) (3687)
- (1) Certification of Violations/Annual Review of Driving Record – 2 Copy Bond (1 White/1 Canary) (3685)
- (1) Employment Eligibility Verification (Form I-9) – Bond (50306)
- (1) Certification of Road Test Pocket Card (006-BC)
- (1) Driver Qualification and Identification Certificate Pocket Card (007-BC)
- (1) Medical Examination Certificate – Laminated Wallet Card (47379)
*Not sold separately
Volume Pricing
| Product Code | Description | 1 - 9 | 10 - 24 | 25 - 49 | 50 - 99 | 100 - 199 |
|---|---|---|---|---|---|---|
|
848
|
Two-Copy Forms Packet
|
$14.08
|
$11.36
|
$9.88
|
$8.67
|
$6.99
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Specification
| Product Code | Description | Size | Need to Purchase a Case? | Number of Plies | Format |
|---|---|---|---|---|---|
|
848
|
Two-Copy Forms Packet
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9.5" x 11.75"
|
100 per case
|
1
|
Folder
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