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[DOT File]New Jersey Department of Health - Government of New Jersey
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NOTE: You must also complete and submit a Family History Information form, which includes medical, cultural and social history information, in order for your Contact Preference form to be accepted for filing. ORIGINAL BIRTH CERTIFICATE INFORMATION Please provide complete and accurate information.
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[DOCX File]Report of Verified Positive Drug Test
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14 cfr part 67 airman medical certificate holder As the Medical Review Officer (MRO), for the company listed herein, in compliance with the provisions of 14 CFR Part 120, I am notifying you of a verified positive test result on the following individual who holds an airman medical certificate issued pursuant to …
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[DOT File]VPH-28, Rabies Vaccination Exemption
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A copy of this certificate must be provided to the owner of the animal listed above and kept as proof of exemption. For dogs, this certificate must be presented with an application for a dog license. VPH-28. JUL 12. Title: VPH-28, Rabies Vaccination Exemption Author: EWhite Keywords:
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[DOCX File]Commercial Driver License Self-Certification
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While FMCSA only requires medical certification for drivers operating in non-excepted, interstate operations, Kentucky requires all CDL holders to be medically certified (601 KAR 1:005) regardless of category selected.
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[DOC File]Best Practices to Organize Your DOT Compliance Filing System
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Medical Certificate 3 years. Annual Review 3 years. Certificate of Violations 3 years. Motor Vehicle Report 3 years. Physical Waiver 3 years. Data Sheet 6 months *NOTE – Always keep the MVR original paperwork from when the driver was hired in the file. Drug & Alcohol. Records of alcohol tests with a .02 or greater result 5 years
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[DOC File]DL-405A
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If you answered no to all of the above activities, you operate in non-excepted interstate commerce and are required to provide a current medical examiner’s certificate (49 CFR 391.45), commonly referred to as a medical certificate or DOT card. Most CDL holders who drive CMVs in interstate commerce are non-excepted interstate commerce drivers.
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[DOC File]DT1435 Request for Forms - Wisconsin Department of ...
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REQUEST FOR FORMS. Wisconsin Department of Transportation. DT1435 10/2013. Send Your Order To: Fax: (608) 246-5632. Mail: Maps and Publications Sales. Wisconsin Department of Transportation. PO Box 7713. Madison, WI 53707-7713. Email: materials-mgt.dbm@dot.wi.gov. All forms listed are available for free distribution. For a complete list of ...
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[DOC File]TR-40-04C
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Sample US DOT Medical Examiner’s Certificate. According to the Federal Motor Carrier Safety Administration (FMCSA), after September 30, 2004, all new DOT physicals must be documented on the revised Medical Examination Report. Enclosed is a sample of the US DOT revised Medical Examination Report and the Medical Examiner’s Certificate from ...
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Dot medical certificate forms