(1) The certificate of employment/experience, which may be issued singly or as part of an application for a commercial motor vehicle operator's endorsement, is on a form furnished by the department, and includes:

(a) the full name of the applicant as it appears on his/ her Montana driver's license or application;

(b) the applicant's date of birth;

(c) the applicant's social security number;

(d) the name and title of the person making the certification and the name of the company which employs the certifier;

(e) in the case of an owner/operator, the license number of at least one commercial vehicle registered to him/her;

(f) the length of employment for this employer, or in the case of a new hire or currently unemployed individual, the name and length of service as a commercial motor vehicle operator for the most recent employer as shown on the application for employment;

(g) a list of the type(s) of vehicles driven and whether the vehicles have air or air/combination brakes, each followed by the cumulative length of experience in that type;

(h) in the case of a new hire or person with less than 3 months employment, a brief statement outlining any driver training conducted by the employer;

(i) the notarized signature of the certifier swearing or affirming that the items in the certification are true and correct to the best of his/her knowledge or belief;

(j) the signature of the applicant swearing or affirming that the information provided to the employer and used to complete the certification is true and correct to the best of the applicant's knowledge and belief.