Form Bfs-103 - Commercial Driver License Certification
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1
2Michigan Department of State
Clear Form
COMMERCIAL DRIVER LICENSE CERTIFICATION
Full Name: (Please Print)
Driver’s License Number:
Date of Birth:
I am applying for the following Commercial Driver License (CDL):
CDL GROUP DESIGNATION: (Choose only one) See reverse side for description of CDL group designations.
GROUP A
GROUP B
GROUP C
CDL ENDORSEMENTS: (Choose as many as you need) See reverse side for description of CDL endorsements.
H-HAZARDOUS MATERIALS
N-TANK VEHICLE
P-PASSENGER VEHICLES*
S-SCHOOL BUS
T-DOUBLE/TRIPLE TRAILERS
*What type of vehicle do you drive when operating a vehicle requiring a passenger endorsement? Select one.
GROUP A
GROUP B
GROUP C
CERTIFYING TO THE TYPE OF COMMERCIAL MOTOR VEHICLE (CMV) DRIVING I WILL DO AS REQUIRED IN 49 CFR PARTS 383 AND 391 (Choose
only one): See the reverse side for more information on driving types.
I will operate, or expect to operate a vehicle used in the following manner:
Non-excepted interstate - I will operate a commercial motor vehicle outside of Michigan and am legally required to have a medical certificate. You must
also provide a medical certification document.
Excepted interstate - I will operate a commercial motor vehicle outside of Michigan, only for an excepted purpose and am not legally required to have a
medical certificate.
Non-excepted intrastate - I will operate a commercial motor vehicle only within Michigan (intrastate commerce) and am legally required to have a medical
certificate.
Excepted intrastate - I will operate a commercial motor vehicle only within Michigan for an excepted purpose and am not legally required to have a
medical certificate.
CDL RESTRICTIONS: (Choose only one)
The vehicle I will operate is:
Equipped with air brakes
Not equipped with air brakes (Restriction Code L)
Please answer all of the following questions. Your driving record will be verified before you take any test. A starred (*) response to one or more of these
questions will disqualify you from obtaining a CDL.
1.
Do you reside at a permanent Michigan address with the intention of remaining in Michigan?
Yes
*
No
2.
Do you have a driver’s license from more than one state? (Section 257.301 of the Michigan Vehicle Code and 49 CFR 383.21 of
Yes
No
the Federal Safety Rules prohibit drivers from having more than one driver’s license.)
3.
Are you currently disqualified or suspended from operating commercial motor vehicles in Michigan or any state?
*
Yes
No
4.
Is your driving privilege currently suspended, revoked, denied, or canceled in Michigan or any state?
*
Yes
No
5.
Unless exempt under the Federal Motor Carrier Safety Administration (FMCSA) rules, do you meet the driver qualification
Yes
*
No
standards to operate a commercial motor vehicle as stated in 49 CFR Part 391? If yes, you should have a valid Medical
Examiner’s Certificate (also known as a DOT card) and a valid FMCSA Skills Performance Evaluation as needed.
6.
Unless exempt under the FMCSA rules, which includes operating a bus for a public transit agency, do you meet the qualification
Yes
*
No
standards to operate a commercial motor vehicle under the Michigan Motor Carrier Safety Act (1963 PA 181) or Michigan Pupil
Transportation Act (1990 PA 187)? If yes, you should have either a valid Michigan Motor Carrier Waiver or a valid Medical
Examiner’s Certificate (also known as a DOT card) if under the MI Pupil Transportation Act.
7.
If required, is the vehicle you will use for the CDL skills test representative of the vehicle that you will operate once licensed?
Yes
No
8.
As required by the Federal Motor Carrier Safety Regulations, Part 383, section 73, please list any state where you held a license within the last ten years.
_______________________
______________________
______________________
______________________
______________________
9.
As required by the Federal Motor Carrier Safety Regulations, Part 383.71, can you present proof of U.S. citizenship or legal
Yes
*
No
presence to obtain a CDL? Acceptable documents are annotated by (●) below.
10.
As required by the Federal Motor Carrier Safety Regulations, Part 383.71, can you present proof of U.S. citizenship or Lawful
Yes
No
Permanent Resident Status to obtain a Hazmat Endorsement? If no, Hazmat Endorsement cannot be issued.
Department of State Use only (Circle Document Type Presented)
Acceptable Proof of U.S. Citizenship:
Acceptable Proof of Legal Presence for Non-U.S. Citizenship:
● Unexpired U.S. passport or passport card
● Valid, unexpired Permanent Resident Card, issued by USCIS or INS.
● Original or certified copy of birth certificate issued by a state,
● Foreign passport with Machine Readable Immigrant visa with Temporary I-551 Language
county, municipal authority, or outlying possession of the U.S.
● Temporary I-551 stamp in valid unexpired Foreign passport or passport card
bearing an official seal.
● Employment Authorization Card (I-766) (unexpired)
● Consular Report of Birth Abroad issued by the U.S.
● Refugee Travel Document (I-571) (valid, unexpired) with stamped I-94
Department of State (FS-240, DS-1350 or FS-545)
● Foreign passport (unexpired) with an I-94 Arrival/Departure form
● Certificate of Naturalization (N-550, N-570 or N-578)
● Foreign passport (unexpired) with an admission stamp and/or U.S. visa
● Certificate of U.S. Citizenship (N-560 or N-561)
● Approved U.S. Department of Labor Certification with Foreign Passport (unexpired) with
a port-of-entry stamp or U.S. visa (unexpired)
● Currently expired USCIS documents accompanied by an I-797 receipt showing a request
in process to extend or adjust status may be accepted if the adjustment or change in
.
status can be verified by SAVE
I certify the information disclosed on this form is true. I understand making a false statement when applying for a driver’s license is a felony.
Signature: X
Date:
BFS-103 (03/17)
Authority granted under Public Act 300, as amended.
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