Driver Statement of On-Duty Hours

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 395.8(j) (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. Driver’s Name: Social Security Number:

Driver’s License: State: Number: Class: End: Rest: Day

1

(Yesterday)

2 3 4 5 6 7

Date

Hours

Worked

Total

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:

On:

Time Date

Driver’s Signature Date

Driver Certification for Other Compensated Work

When employed by or contracted with a motor carrier, a driver must report to the carrier all on-duty time including time driving for other motor carriers. 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 performing any compensated work for any non-motor carrier entity.

Are you currently driving for another motor carrier? Yes No At this time do you intend to drive for another motor carrier while still driving for this company? Yes No I hereby certify that the information given above is true and I understand that once I begin working with this company, if I begin working for any additional lessee/employer(s) for compensation that I must inform this company immediately of such activity.

Driver’s Signature Date

Company Representative’s Signature Date

Andrew Ballman

03-23-2024 03-22-2024 03-21-2024 03-20-2024 03-17-2024 03-24-2024

03-24-2024

03-19-2024 03-18-2024

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