Annual Review of Driving Record Fleet Integrated Services

[5] Annual Review of Driving Record
MOTOR CARRIER INSTRUCTIONS: Review the driver’s motor vehicle record, annual Certification of Violations, and other information described in 49 CFR 391.25 of the Federal Motor Carrier Safety Regulations. Complete the information requested below.
Name of Driver*
First Last
Social Security Number*
Date of Employment*
Month
Day
Year
Home Terminal*
City State
Driver's Licence Number*
Driver's License State*
State
Driver's License Expiration Date*
Month
Day
Year
I have reviewed the driving record of the above named driver in accordance with 49 CFR 391.25 and find that he/she (check on):*
- Meets minimum requirements for safe driving
- Is disqualified to drive a motor vehicle pursuant to Section 391.25
Actions taken with driver:
Carrier Fleet Integrated Services
12930 I St, Omaha, NE 68137
Reviewer Name
First Last
Title*
Reviewer Signature*
Date of Reviewed*
MM slash DD slash YYYY