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Louisiana department of public safety and corrections
Louisiana Department of Public Safety and Corrections
APPLICATION FOR CERTIFIED THIRD PARTY EXAMINER STATUS
7. Are you a full time employee of the tester?
8. Briefly describe your job position/duties:
9. Has your driver’s license been suspended, canceled, or revoked within the last 3 years?
If “Yes”, list the State and reason.
11. Have you ever been convicted of a felony?
12. Have you been provided with a copy of Louisiana R.S. Title 32:408, 408.1, and 408.2, and do
13. Do you promise to conduct all CDL examinations in a manner reflecting their importance to
society, their seriousness to the individual, and their impact of the public safety?
I hereby certify that the above information is true and correct.
STATE OF LOUISIANA
PARISH OF EAST BATON ROUGE
THIRD PARTY EXAMINER/AGENT AGREEMENT
have reviewed the Third Party Tester Agreement entered into by my employer and the Louisiana
Department of Public Safety and Corrections, Office of Motor Vehicles, and do hereby agree with the
terms of said agreement, as it relates to my responsibility as a third-party examiner/agent.
AFFIDAVIT OF THIRD PARTY EXAMINER STATE OF LOUISIANA PARISH OF EAST BATON ROUGE Be it known that I ______________________________, CDL examiner # _____, employed by _______________________________________, a certified Third Party Tester, certify that I am thoroughly knowledgeable of all parts of the CDL Examiner’s Manual, all the standardized instructions, all the specific test scoring criteria, test score sheet, and examiner’s responsibility. All my skills testing is administered at the approved location and scored strictly according to the written standards. My skills test scoring procedure for the in-cab air brake check is conducted in 3 parts known as the “air brake check (1-2-3)” and all 3 parts must be performed correctly for the applicant to receive scored credit. I am aware that a driver applicant’s failure to perform all of the 3 parts is an automatic failure of the vehicle pre-trip inspection test. My Basic Controls Skills Test is described on page 4-1 in the current Essex CDL Examiner’s Manual. All the maneuvers in my BCS course meet the dimensional standards as described in the Examiner’s Manual on pages B1 – B4. The boundary lines for maneuvers in my BCS course are marked with traffic cones for clarity. All the maneuvers described in the Road Test section in the Examiner’s Manual are included in my CDL road test route. I have prepared a road test route map and 4-column route direction sheet meeting specifications given in figure 5-1 in the Examiner’s Manual. The road test route described is followed in its entirety with every CDL driver applicant tested. I maintain at my workplace a detailed record of every driver applicant administered a CDL skills test, whether or not the driver passed or failed the test, in accordance with paragraph 6 of the Third Party Tester Agreement entered into by my employer.
Examiner Applicant’s Signature Date Attested to by:
M E M O R A N D U M To
: Clifton Langlois, CDL Consultant Subject
: Testing Schedules Date
Companies and their examiners are required to obtain and maintain a valid e-mail account which must
be checked on a regular basis for important updates to the CDL program. The use of an e-mail account
will become part of your renewal application. Failure to obtain, maintain, and provide the address of an
e-mail account may result in rejection of your third party tester/examiner application. Please complete
the bottom portion of this form and submit it with your application.
If you have any questions, please contact a CDL Consultant at (225) 223-1163 or (225) 573-5234. Fax (225) 925-3901, Address: Attn – CDL Consultants, P.O. Box 64886, Baton Rouge, LA 70896
Tiziana Pietrangelo, PhD ADDRESS: Department of Basic and Applied Medical Science (BAMS), University “G. d’Annunzio”, Chieti- Pescara; Lab. Clinical Physiology Clinical Research Center (C.R.C.) on Centre of Excellence for Research on Ageing (Ce.S.I.); Via dei Vestini, 29 66013 Chieti (Italy) Tel: +39 0871 355 4554 Fax +39 0871 355 4563; e-mail email@example.com DATE / PLACE OF BIR
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