Post Job Free

Resume

Sign in

Physician Assistant Motor Carrier

Location:
Melbourne, FL
Posted:
February 15, 2024

Contact this candidate

Resume:

Ford ABLF AHO Pap

nt

Public Bunion Stxtement = j

A Pediat sapere y

pee PES WOecocnat interme

COU ireg thie pipee POY Ape ‘ oe

sat Ney ae as ;

Medical Examiner's Certificate

Cot Commercial Dae Ya sical CectBicaere

ry

£

‘coutfy that] have ex airy

ined Last Name: First Name: < ? O <j __ In aocovelance with (please check aniy amet

@ ine Federal Motor Carrier Safety Regulations 149. CFR 391.4)-391.49) and. with knowledge of the driving’ eUtles, fintfils person is qualified, and, if applicable, only when check all thet apply) OR

O the Fedora! Motor Carrlor Safety Regulations (49 CER 393,41-391.49) velth AY applicable Stato variances (which Will only be valid for intrastate Operations), and, with knowledge of the driving duties

‘find this person is qualified and, if applicable, only when (check all that apply. :

CI Wearing corrective tenses C) Accompanied by a

waiver/axomption C] Driving within an exem

(J Wearing hearing aid CO) Accompanied by a Skill Pe:

rformance Evaluation GPE) Caria

pt intraalty 2008 [40 CFR 391.62) (Redionat)

ate 0 Qualified by operation Of 38 CFR 391,64 (Fedeval)

0 Grandfathered from State requinemenis (Stare)

information have pyovided regarding this physical examination Is true and complete. A

Medical Examiner's Certificate Exp nation Date

Complete Medical Bamination Veport Form, /a/

S977) vith ga attachments, gmbodig. SY findings completely and correctly, and is on file in my office, _16/e/sess

= all VS -

fa flical Skminars Signatuge (/,

: v AC- OnNv .

edftal Exalminars N lease print or type) Physician Assistant dvanced Practice Nurse

E : - C oS a ee ee

Chirogracter O Other Practitioner (specify)

Metical Examiner's State License Certificate, or Registration Number Nay oval Registry Numbe:

ps Ms ;

Issuing S$

Co

$ Signa\ure fo — f Dsipgrs License N V4

Nig) Om __ PES SBY. 56-1

eave - * : Be StotePhvinceb Z coded 2-904

nfommation and ls lac oftelal ud oft, Imavoper dag

? : Individuals Handle and secua this Informades “ApMpiiataly ta prevent awtvertent

VW TeCUNMONtS yr Re contro) of auddwelsad Datos. Propgels CC TAYUINA to be mvalnealriat dy 1 QUAONY haQuiRnmeret be Rev L/§2D



Contact this candidate