Or print out completed form and fax to: 973-328-8410
Former Employer: Please provide the following information about this applicant.
Under 49 CFF 391.23, failure to provide the above information should be reported to US DOT (FMCSA) following procedure specified in 49 CFR 386.1.
CONFIDENTIAL REPORT OF PERSONAL REFERENCE
Please indicate your opinion by placing a check (√) in the appropriate column.
CHARACTERISTICS | EXCELLENT | GOOD | FAIR | POOR |
---|---|---|---|---|
Disposition, Tact, Ability to get along with others | ||||
Initiative, Resourcefulness | ||||
Safety Habits | ||||
Driving Skills | ||||
Attitude | ||||
Loyalty |
FOR PROSPECTIVE EMPLOYER’S RECORDS
MAINTAIN THIS INFORMATION IN THE DRIVER QUALIFICATION FILE
FOR 3 YEARS AFTER THE PERSON’S EMPLOYMENT BY THE MOTOR CARRIER CEASES.
Or print out completed form and fax to: 973-328-8410