Get Safety Performance History Records Request - Jj Keller & Associates

Filling out the Safety Performance History Records Request is a crucial step for individuals seeking to verify their employment history in relation to commercial vehicle operation and drug and alcohol testing. This guide will provide you with a comprehensive overview of how to successfully complete the form online, ensuring compliance with regulations and accuracy in your submission.

Follow the steps to complete the request form accurately and efficiently.

1. Press the ‘Get Form’ button to obtain the Safety Performance History Records Request form. This will allow you to access the document in an editable format online.
2. Identify yourself in SECTION 1 by entering your name, social security number, date of birth, and previous employer's details, including email, address, and phone number. You must authorize the release of your safety performance history records.
3. Provide the prospective employer's information. Include their name, phone number, address, and any specific attention needed. Ensure that a confidential method for communication (fax/email) is specified.
4. In SECTION 2, if you are the previous employer, verify the applicant's employment status, job title, and vehicle operation history, indicating whether the applicant drove a vehicle during employment.
5. Complete SECTION 3 to document any accident history, if applicable. Note the details of any accidents that involved the applicant, including dates, locations, and outcomes (injuries, fatalities, hazmat spills).
6. In SECTION 4, answer questions regarding drug and alcohol history, confirming whether the applicant was subject to testing requirements and disclosing any violations or rehabilitation program participation.
7. As the prospective employer, complete SECTION 5a by indicating how the form was sent to the previous employer (fax, mail, etc.) and record the date.
8. Once you receive the information, fill out SECTION 5b with details of what was received, including the method of communication, and any pertinent notes.
9. Review all entered information for accuracy and completeness before saving, downloading, printing, or sharing the completed form as necessary.

Complete your Safety Performance History Records Request form online today for smooth processing and compliance.