On Duty From


 

On Duty Statement Form

  • Instruction: 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 the time at which such driver was last relieved from duty prior to beginning work for such carrier. Rule 395(j)(2) Federal Motor Carrier Safety Regulartions. 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.
  • Driver Name

  • Driver's License

  • Driver's Hours

  • Date Format: MM slash DD slash YYYY
  • Please enter a number from 0 to 24.
  • Date Format: MM slash DD slash YYYY
  • Please enter a number from 0 to 24.
  • Date Format: MM slash DD slash YYYY
  • Please enter a number from 0 to 24.
  • Date Format: MM slash DD slash YYYY
  • Please enter a number from 0 to 24.
  • Date Format: MM slash DD slash YYYY
  • Please enter a number from 0 to 24.
  • Date Format: MM slash DD slash YYYY
  • Please enter a number from 0 to 24.
  • Date Format: MM slash DD slash YYYY
  • Please enter a number from 0 to 24.
  • Driver Certification

  • 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:
  • :
  • Date Format: DD slash MM slash YYYY
  • Driver Certification For Other Compensated Work

  • Instructions: 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 Federal Motor Carrier Safety Regulations 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
  • 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.
  • Date Format: MM slash DD slash YYYY