JJ KELLER part description

Alert: Regulation Change to the Medical Examination Report Form, MCSA–5875 - Effective September 7, 2021
The updated form includes an OMB expiration date of 11/30/2021. As a result, we expect additional form changes from the OMB in the future.


  • Keep your driver qualification files in one secure location
  • Includes driver’s name and date of qualification on front cover of file folder
  • Contains the following forms:
    • (1) Driver Qualification File Contents Sheet – Bond (647-F)
    • (1) Check List for Qualification of New Drivers - 2-ply Snap-out (865)
    • (1) Driver's Application for Employment - Bond (691)
    •  (2) Request for Check of Driving Record - 2-ply Snap-out (732)
    • (1) Medical Examination Report - Bond (47375)
    • (1) Medical Examiner’s National Registry Verification – 2-ply Snap-out (27034)
    • (1) Record of Road Test – 2 Copy Bond (1 White/1 Canary) (652)
    • (1) Certificate Of Compliance with Driver License Requirements - 2-ply Snap-out (1619)
    • (1) Driver Statement of On-Duty Hours, New Hire - 2-ply Snap-out (3688)
    • (1) Certification of Violations/Annual Review of Driving Record - 2-ply Snap-out (3686)
    • (1) Employment Eligibility Verification (Form I-9) – Bond (50306)
    • (1) Certification of Road Test Pocket Card (006-BC)
    • (1) Driver Qualification and Identification Certificate Pocket Card (007-BC)
    • (1) Medical Examiners Certificate – Laminated Wallet Card (47379)
  • File folder is pre-printed with file contents and instructions for each form
  • Letter-size file folder, measures 11-3/4" x 9-1/2"

JJ Keller® is an industry expert in safety and compliance. It provides organizations of all sizes with the right tools and expert advice to create productive, safe, and compliant workplaces. While it does offer managed and consulting services regarding safety and compliance for DOT regulations, it also supplies a wide range of training materials and tools and a comprehensive list of digital and printed publications, forms, and supplies. DOT compliance for fleets has never been easy with JJ Keller. Its wide assortment of decals, placards, and flags helps keep employees and drivers safe and in compliance while on the job.

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