Certification of Violations and Review
COMMERCIAL MOTOR VEHICLE DRIVERS ONLY
FALSIFICATION OF THIS DOCUMENT IS GROUNDS FOR TERMINATION
MOTOR CARRIER
INSTRUCTIONS: Each motor carrier shall at least once every 12 months, require
each driver it employs to prepare
and furnish it with a list of all violations of motor vehicle traffic laws and
ordinances (other than violations involving only parking) of which the driver
has been convicted, or on account of which he/she has forfeited bond or
collateral during the preceding 12 months (Section 391.27). Drivers who have provided information
required by Section 383.31 need not
repeat that information on this form.
DRIVER REQUIREMENTS:
Each driver shall furnish the list as required by the motor carrier above. If the driver has not been convicted
of, or forfeited bond or collateral on account of any violation which must be
listed, he/she shall so certify (Section 391.27).
Please fill out this form, sign below, then click submit when you are finished.