MOTOR VEHICLE DRIVER 'S Certification of Violations Annual 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name in the 'NAME OF DRIVER' field. Ensure that you print clearly for legibility.
  3. Fill in your home terminal location, including city and state, followed by your social security number and driver's license number.
  4. Indicate whether you possess a commercial driver's license by checking 'YES' or 'NO'.
  5. Provide the date of employment and expiration date of your license, along with your date of birth.
  6. List any traffic violations from the past 36 months in the designated fields, including date, offense, location, and type of vehicle operated.
  7. If you have no violations to report, check the box confirming this statement.
  8. Sign and date the certification section at the bottom to complete your submission.

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Speeding: This is a top ten DOT violation and one of the most common traffic infractions for all drivers. Truck drivers are not allowed to speed.
Respiratory illnesses can cause many debilitating symptoms that can hinder a persons ability to drive safely, such as: Difficulty breathing. Stubborn cough. Chest pain.
A copy of the applicants medical certification must be kept on file and employers must maintain its valid status. The medical examiners status on the national registry must be verified and notated in the file. Copy of Drivers License Current state drivers license/CDL (commercial drivers license).

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