This form is to be submitted within 2 working days of the dismissal of any driver and the reason for termination (NAC 706.477).
Within 5 working days after the end of each month, each certificate holder shall also provide the Authority with a list of all drivers whose employment was terminated during the month (NAC 706.477). This list is to be submitted as an attachment in an email to firstname.lastname@example.org .
Name of Driver:
Date of Termination:
Last Day Worked:
Reason for Termination: