Driver License Application

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TEXAS COMMERCIAL DRIVER LICENSE APPLICATION
INTERSTATE DRIVER CERTIFICATION
NOTICE: All information on this application must be in INK.
APPLICANT INFORMATION
LAST NAME
FIRST NAME
DATE OF BIRTH (mm/dd/yyyy)
DRIVER LICENSE NUMBER
SOCIAL SECURITY NUMBER
WHAT IS INTERSTATE COMMERCE?
Trade, traffic, or transportation in the United States which is between a place in a state and a place outside of such state
(including a place outside of the United States); or
Between two places in a state through another state or a place outside of the United States; or
Between two places in a state as part of trade, traffic or transportation, originating or terminating outside the state or the
United States.
Reminder: You may be engaged in interstate commerce even if your vehicle does not leave the state.
INSTRUCTIONS
In order to obtain a commercial driver license which authorizes the operation of a commercial motor vehicle in interstate or foreign com-
merce, you must certify to and meet the qualifications from Federal Rule 49 C.F.R., Part 391. Please review the following requirements.
If you meet these requirements, certify below.
CERTIFICATION
I certify that I:
a. am at least 21 years of age;
b. can read and speak the English language sufficiently to converse with the general public, to understand highway traffic signs
and signals in the English language, to respond to official inquiries, and to make entries on reports and records;
c. am not disqualified to drive a motor vehicle in any state.
SECTION A.
I FURTHER CERTIFY THAT I: (Check the appropriate box(es) below)
1.
Do not have a loss of a foot, a leg, a hand, or an arm, or have been granted a waiver;
2.
Do not have an impairment of:
i.
A hand or finger which interferes with prehension or power grasping; or
ii. An arm, foot, or leg which interferes with the ability to perform normal tasks associated with operating a motor
vehicle; or any other significant limb defect or limitation which interferes with the ability to perform normal tasks
associated with operating a motor vehicle;
3.
Do not have an established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control;
4.
Do not have a current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis, or
any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, or congestive
cardiac failure;
5.
Do not have an established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with my ability to
control and drive a motor vehicle safely;
6.
Do not have a current clinical diagnosis of high blood pressure likely to interfere with my ability to operate a motor vehicle
safely;
7.
Do not have an established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or
vascular disease which interferes with my ability to control and operate a motor vehicle safely;
(OVER)
CDL-4 (Rev. 11/14)

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