Drug and Alcohol Testing Passenger Motor Carrier Affidavit of Applicability

 

Owner or Owner Representative: Review the following and fill out the form below.

Per Section 507-A of the NY State Vehicle and Traffic Law, Passenger Motor Carriers must conduct pre-employment and random drug / alcohol testing if the following apply:

  • The motor carrier offers for-hire services, and
  • operates one or more vehicles with a seating capacity of 9 or more passengers (including the driver).

Required fields are marked with an asterisk (*).

 

REGISTRANT INFORMATION

Complete the following registrant information:

(i.e. XXXXX)

 

STATEMENT OF SERVICES

Select the option that applies: *

 

ACKNOWLEDGEMENT & CERTIFICATION

I agree, and it is my intent, to sign this document by entering my name and title below and by electronically submitting this document to the New York State Department of Motor Vehicles. I understand that by electronically signing and submitting this document in this fashion, it is the legal equivalent of having placed my handwritten signature on the submitted document and this affirmation. I also understand and agree that by electronically signing and submitting this document in this fashion, I am affirming to the truth of the information contained therein.

I affirm the information I have provided on this form is true and complete. I understand that making any false statement on this form, or submitting any documentation in support of this form that is false, may be punishable as a criminal offense.

Certify by checking 'I AGREE' and provide information for the individual completing this form: *