Special Certificate Application, Chp 295 - California Highway Patrol Page 2
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1
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3
4Please read each item carefully and sign at the bottom of the
2.
Has been the cause of three accidents within the last 12 months .
page.
3.
Has been the cause of an accident resulting in a fatality, serious
injury, or $750 damage within the preceding 24 months.
APPLICANT'S REQUIREMENTS - ORIGINAL
4.
Has violated any law, rule, or regulation for the safe operation of
1.
A valid driver license.
a vehicle for which the certificate was issued.
2.
Current medical report (DL-51) and medical examiner's certificate.
5.
Has violated any restriction of the certificate.
3.
Ten-year driving history printout.
6.
Has made a false statement on the application.
Is a negligent or incompetent operator.
4.
$32 for fingerprints plus $25 for the DL45.
7.
5.
Licensing eligibility document (e.g., permit, temporary license).
8.
Habitually uses or is addicted to alcohol or drugs.
Does not meet minimum medical standards.
6.
The applicant will be fingerprinted by the CHP. The fingerprints
9.
Has been convicted of specific crimes within the past seven
will be sent to the Department of Justice and, if applicable, to the
10.
Federal Bureau of Investigation for a criminal background review.
years.
Has been convicted of an offense, other than a sex offense, that
11.
is punishable as a felony within the past seven years.
APPLICANT'S REQUIREMENTS - RENEWAL
Has been dismissed for a cause related to pupil transportation
1.
A valid driver license.
12.
safety.
2.
Current medical report (DL-51) and medical examiner's certificate.
Has been convicted, within the preceding seven years, of any
3.
Documentation of required training.
13.
offense related to the use, sale, possession, or transportation of
4.
$12 for the DL45.
drugs.
Has been arrested for or charged with any sex offense, as
APPLICANT'S REQUIREMENTS - CERTIFICATE UPGRADE OR
14.
defined in Section 44010 of the Education Code.
DOWNGRADE
Violates Section 5387(b) of the Public Utilities Code (driving a
1.
A valid driver license.
15.
bus without a current/valid driver license of the proper class, a
2.
Current medical examiner's certificate.
passenger vehicle endorsement, or the required certificate).
3.
$12 for DL45.
REQUIRED TESTS
PHYSICAL QUALIFICATIONS
An applicant must pass a written test on the laws and regulations
1.
An applicant is physically qualified to drive a vehicle if the person:
Has no loss of a foot, a leg, a hand, or an arm, or has been
1.
governing passenger transportation safety and safe driving
granted a waiver pursuant to Section 391.49 Federal Motor
practices. The test may be taken prior to the return of the criminal
Carrier Safety Regulations (FMCSR).
background review. A written test is not required for a VDDP
Has no impairment of a hand or finger which interferes with
certificate.
2.
prehension or power grasping; or, an arm, foot, or leg which
2.
An applicant must pass a drive test using a vehicle comparable to
interferes with the ability to perform normal tasks associated with
those to be driven by the applicant. The drive test includes a pre-
operating a motor vehicle; or any other significant limb defect or
trip inspection of all gauges, instruments, and controls, with critical
limitation which interferes with the ability to perform normal tasks
emphasis on brake systems and their operation. The drive test
associated with operating a motor vehicle; or has been granted a
shall not be taken prior to the return of the criminal background
waiver pursuant to Section 391.49 FMCSR.
review. Restrictions may be placed on the certificate depending
Has no diabetes currently requiring insulin for control.
3.
on the type of vehicle used during the drive test. A drive test is not
Has no myocardial infarction, angina pectoris, coronary
required for a VDDP certificate.
4.
insufficiency, thrombosis, or any other cardiovascular disease of
An applicant for a school or youth bus driver certificate must pass
3.
a variety known to be accompanied by syncope, dyspnea,
a written first aid test. This test may be waived if the applicant
collapse, or congestive cardiac failure.
possesses a current first aid certificate issued by the American
Has no respiratory dysfunction likely to interfere with the ability to
5.
Red Cross or by an organization approved by the Emergency
control and drive a motor vehicle safely.
Medical Services Authority, or possesses a current license as a
Has blood pressure in accordance with Part 391.43(f) FMCSR.
6.
physician and surgeon, osteopathic physician and surgeon, or
Has no established medical history or clinical diagnosis of
registered nurse, or a current certificate as a physician's assistant
7.
rheumatic, arthritic, orthopedic, muscular, neuromuscular, or
or emergency medical technician.
vascular disease which interferes with the ability to control and
4.
Tests for certificate upgrades may be required.
operate a motor vehicle safely.
Has no established medical history or clinical diagnosis of
MANDATORY DISQUALIFYING CRITERIA
8.
epilepsy or loss of consciousness.
DMV shall deny or revoke the certificate if the applicant:
Has no mental, nervous, organic or functional disease or
1.
Has been convicted of a sex offense defined in Section 44010 of
9.
psychiatric disorder likely to interfere with the ability to drive a
the Education Code.
motor vehicle safely.
2.
Has been convicted, within the preceding two years, of an offense
Has distant visual acuity of at least 20/40 (Snellen) in each eye
involving the use, possession, or sale of drugs.
10.
with or without corrective lenses and at least 70 degrees in the
3.
Has been convicted, within the preceding three years, of hit and
horizontal meridian in each eye, and the ability to recognize the
run, reckless driving, or driving under the influence.
colors red, green, and amber.
4.
Has been convicted of a violent or serious crime per Sections
First perceives a forced whispered voice at not less than 5 feet in
667.5(c) or 1192.5(c) of the Penal Code.
11.
the better ear with or without the use of a hearing aid.
5.
Fails to pass the written test(s) or drive test.
Does not use an amphetamine, narcotic, or any habit-forming
6.
Within the preceding three years, has had driving privileges revoked
12.
drug.
or suspended, or has been placed on probation for any reason
Has no current clinical diagnosis of alcoholism.
involving unsafe operation of a motor vehicle.
13.
I hereby certify that I have read, or had read to me, and that I
DISCRETIONARY DISQUALIFYING CRITERIA
understand all of the above.
DMV may deny, suspend, or revoke the certificate if the applicant:
!
1.
Has committed any act involving moral turpitude regardless of when
the act was committed.
Applicant's Signature
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