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<br />DOL CDL Third Party Examiner 25 of 28 DOL K7951 <br />AG Rev June 2022 <br />ATTACHMENT F: EXAMINER CONSENT FORM <br /> <br /> <br /> <br /> <br />1. I attest to reading the contract between the Examiner and the Department <br />of Licensing, specifically the Statement of Work (SOW). The SOW outlines <br />my duties and responsibilities as a Third Party Examiner. <br /> <br />2. Any disciplinary actions taken by the department will be reflected on me as <br />the examiner. <br /> <br />3. I have been provided a copy of the Compliance Matrix and understand the <br />consequences outlined in the document. <br /> <br />4. I understand I am not able to test an individual that I have trained. <br /> <br />5. I will keep all information regarding drivers who are being tested <br />confidential. <br /> <br />6. It is my responsibility to maintain my eligibility by conducting 10 tests per <br />calendar year. <br /> <br />7. I will provide service to all classes of vehicle I am contracted and certified to <br />test. <br /> <br /> <br /> <br />Signature: ___________________________________________________ <br /> <br /> <br />Name: Date: <br />DocuSign Envelope ID: AC966A65-E68A-4258-A8B9-AE46FE8283C3