Form Mv3001 - Wisconsin Driver License (Dl) Application Page 2
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3WISCONSIN DRIVER LICENSE (DL) APPLICATION
An unexpired Wisconsin
driver license is acceptable
Wisconsin Department of Transportation
photo ID for voting.
Clear Form
MV3001
12/2013
Ch. 343 Wis. Stats.
s. 5.02(6m) Wis. Stats.)
(
Acceptable proof of name and date of birth, legal presence, identity and Wisconsin residency are required.
NOTICE TO MALES AGE 18–25 By submitting this application, you
APPLICATION COMPLETION REQUIREMENTS
consent to be registered with the Selective Service System, if required
ALL applicants, complete the top section on back.
by Federal law. You also authorize the Department of Transportation to
If under age 18, also complete the ‘UNDER AGE 18’ section below.
forward any information contained in this application that is requested by
CDL applicants, complete the ‘CDL APPLICANT ONLY’ section below.
the Selective Service System for the purpose of registering you as provided
Your Federal Medical Certificate is required unless you drive a school
in s. 343.14(2)(em) and s. 343.234 Wis. Stats.
bus or drive for a political subdivision.
WARNING Any applicant for a driver license who presents fraudulent
DONOR Check the box if you wish to help others by donating your organs,
or altered documents or makes a false statement to the issuing officer or
tissue and eyes upon your death. Your gift will be used to save and improve
agency, may be subject to a fine of not more than $1,000, imprisonment for
lives through transplantation, therapy, research or education. If you are at
not more than six months or both. The driver license privilege may also be
least 18, checking the box indicates your legal consent for donation. You do
revoked for one year. (s. 343.14(5) Wis. Stats.)
not have to answer this question to obtain a license.
OPT OUT Under Wisconsin open records laws, WisDOT must provide
information from its records to requesters. If you do not want your name
ADA The Wisconsin Department of Transportation complies with the
and address included in requests we receive for ten or more records, you
Americans with Disabilities Act (ADA).
may ask WisDOT to withhold your name and address from those lists by
SOCIAL SECURITY NUMBER (SSN) If you have a SSN, you must
checking the box on the application.
provide it (s. 343.14(2)(bm) Wis. Stats.). Your SSN may be used for
purposes authorized by law and to link your driver license and vehicle
INSURANCE No person may operate a motor vehicle in Wisconsin unless
registration records. Your SSN must correspond with the number issued by
the owner or driver of the vehicle has liability insurance in effect for the vehicle
the Social Security Administration. Federal regulation 49 CFR, Part 383.153
being operated and carries proof of insurance whenever driving. Failure to
requires a SSN for commercial driver license privileges.
have insurance could result in a fine up to $500. Refer to s. 344.61-344.65
Wis. Stats. for full details.
COMMERCIAL DRIVER LICENSE APPLICANT ONLY
If applying for a HAZMAT endorsement (HME), complete Driver License Hazardous Materials Endorsement Application, form MV3735.
If applying for a school bus endorsement, complete School Bus or Alternative Vehicle License Information Request, form MV3740.
1. In the past 5 years, have you had a loss of
YES
NO
6. Is the vehicle you will be operating equipped
YES
NO
consciousness or muscle control caused by a
with air brakes?
neurological condition, for example, seizure disorder?
7. Do you meet all the driver qualifications as required
YES
NO
by 49 CFR 391 to operate a commercial vehicle?
2. In the past 2 years, have you taken insulin
YES
NO
If not, see Motor Carrier Safety FAQs, publication
to control a diabetic condition?
BDS218.
3. In the past 2 years, have you taken oral
YES
NO
YES
NO
8. School Bus, CDL Instructional Permit and
medication to control a diabetic condition?
New CDL Class/Endorsement Applicants Only.
Is the vehicle in which you will take the commercial
driver license skills test representative of the type
YES
NO
4. Is your hearing impaired? (hard of hearing)
of vehicle you will operate or intend to operate?
9. School Bus Applicants Only.
YES
NO
5. Have you held a valid operator's license in the
YES
NO
Have you been convicted of an offense identified
last 10 years from any jurisdiction (state) other
on School Bus or Alternative Vehicle License
Information Request, form MV3740 in Wisconsin
than Wisconsin?
If yes, list all states:
or any other jurisdiction? If yes, list date and place:
DRIVER LICENSE APPLICANT UNDER AGE 18 ONLY
Applicant Certification: I certify that in the past six months I have not
Sponsor Certification: As the adult sponsor under s. 343.15 Wis. Stats.,
been ticketed for a moving violation that has or may result in a conviction.
I accept liability and verify that the minor is not a habitual truant and meets the
I understand that falsifying this statement will result in the cancellation of
educational requirements for licensure. If required for this application, I certify
my probationary license. Applicant Signature - Required.
that the applicant has accumulated at least 30 hours of driving experience,
10 of which were at night.
Minor Name - Print
X
School Certification: I certify that this applicant is enrolled in approved
Sponsor Name - Print
Relationship to Applicant
behind-the-wheel training which begins no later than 60 days from date signed.
School ID Number
School Name
Sponsor Wisconsin DL/ID Number
Sex
(mm/dd/yyyy)
Birth Date
X
Official WisDOT Test Results
(Sponsor Signature -Must be Witnessed by DMV Agent or Notarized)
(line out if not used)
Highway Sign Test
State of Wisconsin County of
Subscribed and sworn to before me on this date
Knowledge Test
Pass
Pass
Fail
Fail
X
X
(DMV Authorized Agent or Notary Signature)
(My Commission Expires)
(Authorized School Official/Instructor Signature)
(Date Signed)
DO NOT Use Notary Seal
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