Driver Application form

U.S DEPARTENT OF TRANSPORTATION

Mortor carrier safty program

Annual review of driving record

Social secutrity Number

This day i reviewed the driving record of the above named drivered in accordance with 395.21 of a fedral motor carrier safty regulations.I considerded any evidence that the driver has violated applicable provisons of federal motor carrier safty regulations and a hazardous materials regulations . I considered the driver accident records and any evidence that he/she has violated laws governing the operations od motor vehicles and gave great to violations such as speeding , reckless deiving and operation while under the influence of alcihol or drugs , that indicates that the driver has exhibited a disregard for the safety of the public. having done above, i find that

The driver meets minimum requirement for safe driving
The driver is disqualifies to drive a motor vehicle pursuant to 391.15

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