JJ KELLER part description

NOTICE: The latest Medical Examiner’s Certificates show an OMB expiration date of 11/30/2021 in the upper-right corner. On Dec. 4, 2018, the Federal Motor Carrier Safety Administration (FMCSA) informed us that there is no specific deadline when forms dated 8/31/2018 or 9/30/2019 can no longer be used, though they do “suggest” that the 2019 or 2021 versions be used in place of the 2018 version. The FMCSA also announced that it “is encouraging the State Driver's Licensing Agencies (SDLAs) to accept these forms with expiration dates of 08/31/2018, 09/30/2019, and 11/30/2021.” Therefore, all three versions remain acceptable but upgrading to the 2019 or 2021 versions is advised.


  • Retail packaged - Shrinkwrapped with header card
  • Complete package of forms required by 49 CFR 391.51
  • Includes folder pre-printed with file contents and instructions for each form
  • Each folder contains the following forms:
    • (1) DQ File Contents Sheet - one-ply bond only - 3694
    • (1) Checklist for Qualification of New Drivers - 506541
    • (1) Driver's Application for Employment - 691
    • (1) Employment Eligibility Verification Form I-9 - 50306
    • (2) Request for Check of Driving Record - 506540
    • (1) Certification of Compliance with Driver License Requirements - 1617
    • (1) Record of Road Test - two-ply bond only; includes 6-B Certification of Road Test - 652
    • (1) Driver Statement of On-Duty Hours - New Hire - 3687
    • (1) Certification of Violations/Annual Review of Driving Record - 3685
    • (1) Medical Examination Report - 47375
    • (1) Medical Examiners Certificate - 2-ply - 47379
    • (1) Medical Examiners National Registry Verification Form - 27033
    • (1) Certification of Road Test (6-BC) Wallet Card - 279
    • (1) DQ & Identification Certificate (7-BC) Wallet Card - 324
    • (1) Folder

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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