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Safety Performance History Records Request - Padded Format
Includes 50 forms (8-1/2" x 11") per pad. Read more.
Effective January 6, 2023: Motor carriers will no longer need to contact a CDL driver’s former employers to inquire about FMCSA drug or alcohol testing violations. Motor carriers must run a Drug & Alcohol Clearinghouse query instead. Former employers must still be contacted for employment verification and the driver’s crash history. Therefore, drug/alcohol questions have been removed from the Safety Performance History Records Request form (No. 9620 or 9652). The revised Previous Employer Alcohol & Drug Test Information form (No. 6827 or 6828) should be used to obtain information about an applicant’s DOT drug or alcohol violations that occurred under a non-FMCSA agency (FAA, FTA, FRA, PHMSA, etc.).
Product Code:
9652
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Overview
- Use 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 from a driver/applicant's previous employers
- Covers driver/applicant's authorization to release information; employment verification and accident information
- Padded format, 50 sheets per pad
- Measures 8-1/2" W x 11" L
Interested in a license to use this form electronically?
For a quote to use this form electronically, such as on your company intranet, or with form-fillable fields, contact us at customsolutions@jjkeller.com or 1-800-327-6868 to discuss. Learn more.
Volume Pricing
| Product Code | Description | 1 - 2 | 3 - 5 | 6 - 11 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Higher quantities available. Pricing reflected in shopping cart or call 1-877-564-2333 to order. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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9652
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Padded format, 8-1/2" x 11"
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$14.84
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$12.39
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$9.81
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Specification
| Product Code | Description | Format | Number of Plies | Size | Need to Purchase a Case? | Country Of Origin |
|---|---|---|---|---|---|---|
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9652
|
Padded format, 8-1/2" x 11"
|
Sheet
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1
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8.5" x 11"
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50 per case
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USA
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