Form Cdl-102 - Cdl Certification For Military Waiver Of Skills Test printable pdf download

CDL CERTIFICATION FOR MILITARY WAIVER OF SKILLS TEST

Waiver is available for ONLY up to one year after discharge or for active military and active duty New York National Guard.

(bring copy of your DD-214 or NGB-22 military discharge or military ID card to DMV)

PART 1 - APPLICANT CERTIFICATION (please print)

Name: _________________________________________________________________________________________________________

Last

First

Middle

Date of

License ID

Social Security

Birth:

Number:

I certify that during the 2-year period immediately preceding this date:

I have not had more than one driver’s license in more than one jurisdiction at one time.

I have not had my license suspended, revoked, cancelled or denied.

I have not had any convictions for any of the disqualification offenses listed below:

Any alcohol or drug related offenses

Leaving the scene of an accident

Commission of a felony involving the use of a motor vehicle

Driving a commercial motor vehicle (CMV) when, as a result of prior violations committed operating a CMV, the driver’s

commercial driver license (CDL) is revoked, suspended, or canceled, or the driver is disqualified from operating a CMV

Causing a fatality through the negligent operation of a CMV, including but not limited to the crimes of motor vehicle manslaughter,

homicide by motor vehicle and negligent homicide

Use of a motor vehicle in a felony involving the manufacturing, distribution or dispensing of a controlled substance

Violations of military, state, or local law relating to motor vehicle traffic control (other than a parking violation) arising in

connection with any traffic accident and have no record of an accident in which I was at fault

I have not had more than one (1) conviction for any of the serious violations listed below:

Following a vehicle ahead too closely

Driving a CMV without obtaining a CDL

A violation arising in connection with a fatal accident

Reckless driving

Improper or erratic lane changes

Driving a CMV without the proper class of CDL and/or

endorsements for the specific vehicle group being operated or

Excessive speeding (15 mph or more above the posted speed limit)

for the passengers or type of cargo being transported

Any violation for Railroad Highway Grade Crossing

Driving a CMV without a CDL in the driver’s possession (Any individual who provides proof to the enforcement authority that

issued the citation, by the date the individual must appear in court or pay any fine for such a violation, that the individual held a

valid CDL on the date the citation was issued, shall not be guilty of this offense.)

I also certify that:

I have not had my license or privilege to drive a motor vehicle suspended, revoked or cancelled during the immediately preceding

4 years.

I have not been convicted of a violation of NRS 484.37955 (vehicular homicide).

I have not been convicted during the immediately preceding 7 years of a violation of driving under the influence of alcohol or drugs.

I have not had three (3) or more convictions of moving traffic violations during the immediately preceding 4 years.

I have not been convicted of any of the offenses related to the use or operation of a motor vehicle which must be reported to the

National Driver Register Problem Driver Pointer System during the immediately preceding 4 years (pursuant to the provisions of

Parts 1327 et seq. of Title 23 of the Code of Federal Regulations).

I also certify that:

I am regularly employed or was regularly employed within the last year in a military position requiring operation of a

commercial motor vehicle; and

I was exempt from the CDL requirements in 49CFR 383.3(c), Exception for certain military drivers; and

For at least two years immediately preceding this date if actively serving, or the date of my military discharge, I operated a

vehicle of the same class and type as the one I want to be licensed to drive.

I certify I am qualified for the waiver of my driving skills under the conditions above, and that the information I have given is true.

IMPORTANT: Making a false statement in any license or non-driver ID card application, or in any proof or statement in connection

with it, or deceiving or substituting, or causing another person to deceive or substitute in connection with such application, may

subject you to criminal prosecution for a misdemeanor or felony under the Vehicle and Traffic Law and/or the Penal Law.

Signature:

Date:

dmv.ny.gov

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Form Cdl-102 - Cdl Certification For Military Waiver Of Skills Test

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