Driving Certification For Maryland Commercial Driver'S License Holders Form (B/w)
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1Motor Vehicle Administration
Motor Vehicle Administration
DL-330 (07-15)
6601 Ritchie Highway, N.E.
6601 Ritchie Highway, N.E.
Room 145, Attn: CDL Med Cert
Glen Burnie, Maryland 21062
Glen Burnie, MD 21062
Driving Certification for Maryland Commercial Driver’s License Holders
PLEASE READ AND COMPLETE.
Applicant Information (Please Print): *Indicates a required field
Driver License Number*
Date of Birth (Month/Day/Year)* Current Medical Certificate Expiration
Date (Month/Day/Year)*
First Name*
Middle Name
Last Name*
Suffix
** You must provide either a Contact
Contact Phone Number**
Phone Number or Email Address
Email Address**
Certification: Select one of the following four options:
I am qualified to operate a commercial motor vehicle*
Interstate and have a valid medical examiner’s certificate. (NI)
Intrastate (within MD) OR I am under the age of 21 OR I have an approved MVA CDL Medical Waiver. (NA)
Interstate and am exempt from obtaining a medical examiner’s certificate. (EI)
Intrastate (within MD) and meet all applicable MD State requirements. (EA)
I certify, under penalty of perjury that the statements made by me on this application are
true and correct to the best of my knowledge, information and belief.
__________________________________________________
________________________________________
Signature
Date
For more information, please call: 410-768-7000 (to speak with a customer agent).
TTY for the hearing impaired: 1-800-492-4575. Visit our website at:
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Parent category: Business