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Safety Performance History Records Request - Snap-Out Format (01501)
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Safety Performance History Records Request - Snap-Out Format

Features 3-ply forms (8-1/2" x 11-3/4") with carbon copy. 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: 9620
List Price: $10.23
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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
  • Snap-out format
  • Three plies
  • Carbon copy
  • Measures 8-1/2" x 11-3/4"
  • Imprinting available. Call toll-free for pricing.

Volume Pricing

Volume Pricing
Product Code Description 10 - 49 50 - 99 100 - 249
Higher quantities available. Pricing reflected in shopping cart or call 1-877-564-2333 to order.
9620
Snap-out format, carbon copy, 8-1/2" x 11-3/4"
$1.02267
$0.98163
$0.77464

Specification

Specification
Product Code Description Format Number of Plies Size Need to Purchase a Case? Country Of Origin
9620
Snap-out format, carbon copy, 8-1/2" x 11-3/4"
Snap-out
3
8.5" x 11.75"
1,000 per case
USA

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