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CERTIFICATE OF DRIVER’S ROAD TEST

Instructions: If the road test is successfully completed, the person who gave it shall complete a certificate of the driver’s road test. The original or copy of the certificate shall be retained in the employing motor carrier’s driver qualification file of the person examined and a copy given to the person who was examined. (49 CFR 391.31(e)(f)(g))

CERTIFICATION OF ROAD TEST

Driver’s Name _____________________________________

Social Security Number _____________________________

Operator’s or Chauffeur’s License Number ______________

State ____________________________________________

Type of Power Unit _________________________________

Type of Trailer(s) __________________________________

If passenger carrier, type of bus ______________________

This is to certify that the above-named driver was given a road test under my supervision on _______________, 20____, consisting of approximately ______ miles of driving.

It is my considered opinion that this driver possesses sufficient driving shill to operate safely the type of commercial motor vehicle listed above.

(Signature of Examiner)_______________________________________

(Title) ____________________________________________________

(Organization & Address of Examiner) ___________________________