I acknowledge, that i have the right to due process as identified in 49cfr. This release is in accordance with dot regulation 49 cfr part 40, section 40. Medical certificate and affidavit must be submitted. Refer to title 17 of the new york codes, rules and regulations nycrr part 820 for specific requirements. Failure to complete required areas can place both the applicant and carrier in violation of federal law. I operate or expect to operate in interstate commerce, but operation exclusively in transportation or operations excepted under 49 cfr 390. Links to sources outside the legislatures site are provided for the convenience of the user and no representation is. I further certify that i am exempt from the physical provisions of 49 cfr, part 391 390, and will operate a commercial motor vehicle only in the following capacity. Chief, medical programs division, federal motor carrier safety.
All class a, b, and c drivers who do not fall under any of the other categories all class a, b, and c drivers granted a medical variance, federal vision or diabetes exemptions, or skill performance evaluation certificate spe v restriction. Use the pdf linked in the document sidebar for the official electronic format. Applicants must meet the eligibility requirements listed in federal regulations 49 cfr part 391 qualifications of drivers or state regulations 540 cmr 2. Pdf view link permanent link bookmark this location view toggle go to top of document. The department of transportations dot rule, 49 cfr part 40, describes required procedures for conducting workplace drug and alcohol testing for the federally regulated transportation industry. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven 7 years for a total of ten 10 years. Some of those exceptions are discussed in the following pages. Drivers meeting the definition of farm vehicle driver who operate straight trucks are exempted from all driver qualification requirements of part 391. The application must be addressed to the applicable field service center, fmcsa, for the state in the applicant is licensed, or where the coapplicant motor carriers. Am exempt from the physical provisions of 49 cfr, part 391 390 as i will operate a commercial motor vehicle only in the capacities i have checked below. This document has been published in the federal register. The rules in this part do not apply to drivers of pipeline welding trucks as defined in 49 cfr 390. The rules in this part do not apply to drivers of pipeline welding trucks, as defined in 49 cfr 390.
Carriers do not need to use this exact form, but must have a completed and signed employment application for all drivers that contains the information listed in 49 cfr 391. I also certify that i do not have a drivers license from any other state or licensing jurisdiction, nor am i subject to any disqualification, suspension, revocation, cancellation or other sanction of my driving privilege. The following persons must be medically examined and certified in accordance with 391. Part 391 federal motor carrier safety administration. Federal motor carrier safety administration fmcsa skill. All class a, b, and c drivers granted a federal vision exemption. A copy of the medical certificate must be mailed, faxed, or emailed to the north dakota drivers license division. I understand that information to be released in section iia by my previous employer, is limited to the following dot regulated testing items. Procedures for transportation workplace drug and alcohol. The rules in part 391, subpart ephysical qualifications and examinationsdo not apply to drivers of covered farm vehicles, as defined in 49 cfr 390.
Medical certificate and selfcertification must be submitted all class a, b, and c drivers who do not fall under any of the other categories. I authorize release of the information contained on this form as required under 49 cfr 40. The federal motor carrier safety regulations 49 cfr 391. Do you have a written process to identify drivers that should be disqualified, and a process for reinstatement. Oklahoma commercial driver license medical selfcertification. There are specific exceptions to some of these regulations for vehicles operated strictly within new york state. I acknowledge, that i have the right to due process as identified in 49cfr 391. All class a, b, and c drivers granted a federal vision or diabetes exemption. The electronic code of federal regulations e cfr is a currently updated version of the code of federal regulations cfr.
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