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DRIVER STATEMENT OF ON-DUTY HOURS

(For Newly Hired Drivers)

Motor carriers when using a driver for the first time shall obtain from the driver a signed statement giving the total time on-duty during the immediately preceding 7 days and time at which such driver was last relieved from duty prior to beginning work for such carrier. Rule (395.80) (2) Federal Motor Carrier Safety Regulations. NOTE: Hours for any compensated work during the preceding 7 days, including work for a non-motor carrier entity, must be recorded on this form.

Hours Worked — Preceding 14 Days
DAY 1234567 891011121314
DATE
HOURS
WORKED
Total 7 Days: 0 hrs Total 14 Days: 0 hrs
Certification — Last Relieved From Work

I hereby certify that the information given above is correct to the best of my knowledge and belief, and that I was last relieved from work at:

Driver's Signature *
Driver Certification for Other Compensated Work

When employed by a motor carrier, a driver must report to the carrier all on-duty time including time working for other employers. The definition of on-duty time found in Section 395.2 paragraphs (8) and (9) of the FMCSR includes time performing any other work in the capacity of, or in the employ or service of, a common, contract or private motor carrier, also performing any compensated work for any non-motor carrier entity.

Are you currently working for another employer? *
At this time do you intend to work for another employer while still employed by this company? *

I hereby certify that the information given above is true and I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity.

Driver's Signature *