Skill Performance Evaluation Certificate
Name of Issuing Agency: _______________________________
Agency Address: _______________________________
Telephone Number: ( ) _______________________________
Issued Under 49 CFR 391.49 , subchapter B of the Federal Motor Carrier Safety Regulations
Driver's Name: _______________________________
Effective Date: _______________________________
SSN: _______________________________
DOB: _______________________________
Expiration Date: _______________________________
Address: _______________________________
Driver Disability: _______________________________
Check One: ______New ______Renewal
Driver's License: _______________________________
(State) (Number)
In accordance with 49 CFR 391.49 , subchapter B of the Federal Motor Carrier Safety Regulations (FMCSRs), the driver application for a skill performance evaluation (SPE) certificate is hereby granted authorizing the above-named driver to operate in interstate or foreign commerce under the provisions set forth below. This certificate is granted for the period shown above, not to exceed 2 years, subject to periodic review as may be found necessary. This certificate may be renewed upon submission of a renewal application. Continuation of this certificate is dependent upon strict adherence by the above-named driver to the provisions set forth below and compliance with the FMCSRs. Any failure to comply with provisions herein may be cause for cancellation.
CONDITIONS: As a condition of this certificate, reports of all accidents, arrests, suspensions, revocations, withdrawals of driver licenses or permits, and convictions involving the above-named driver shall be reported in writing to the Issuing Agency by the EMPLOYING MOTOR CARRIER within 30 days after occurrence.
LIMITATIONS:
NOTICE: To all MOTOR CARRIERS employing a driver with an SPE certificate. This certificate is granted for the operation of the power unit only. It is the responsibility of the employing motor carrier to evaluate the driver with a road test using the trailer type(s) the motor carrier intends the driver to transport, or in lieu of, accept the trailer road test done during the SPE if it is a similar trailer type(s) to that of the prospective motor carrier. Also, it is the responsibility of the employing motor carrier to evaluate the driver for those non-driving safety-related job tasks associated with the type of trailer(s) utilized, as well as, any other non-driving safety-related or job-related tasks unique to the operations of the employing motor carrier.
The SPE of the above-named driver was given by an SPE Evaluator. It was successfully completed utilizing the above-named power unit and ________ (trailer, if applicable)
The tractor or truck had a ________ transmission.
Please read the NOTICE paragraph above.
Name: _______________________________
Signature: _______________________________
Title: _______________________________
Date:_______________________________
49 C.F.R. §391.49