Skill Performance Evaluation Certificate Application Form Page 8
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25(Organizadon and Address of Examiner)
CERTIFICATE OF DRIVER’S ROAD TEST
If the road test is successfully completed, the person who gave it shall complete a certifi-
I n s t r u c t i o n s :
cate of the driver’s road test. The original or copy of the certificate shall be retained in the employing
motor carrier’s driver qualification file of the person examined and a copy given to the person who
was examined. (49 CFR 391.33(e)(f)(g))
CERTIFICATION OF ROAD TEST
Driver’s Name
Social Security Number
Operator’s or Chauffeur’s License Number
State
Type of Power Unit
Type of Trailer(s)
If passenger carrier, type of bus
This is to certify that the above-named driver
was given a road test under my supervision on
, 19~, consisting of
miles of driving.
approximately
It is my considered opionion that this driver
possesses sufficient driving shill to operate safely the
type of commercial motor vehicle listed above.
(Signature of Examiner)
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