Application For Military Skills Test Waiver Form

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APPLICATION FOR MILITARY SKILLS TEST WAIVER
The Commercial Driver License (CDL) skills test waiver form may be used by service members who are currently licensed and who are or were
employed within the past year (12 months) in a military position requiring the operation of a military motor vehicle equivalent to a Commercial Motor
Vehicle (CMV). This waiver allows a qualified service member to apply for a CDL without skills testing. CDL knowledge (written) test(s) cannot be
waived. The transfer of School Bus(S) and/or Passenger (P) endorsements under this Waiver Program are prohibited.
APPLICANT INFORMATION
NAME (Last, First, Middle)
STATE /DRIVER LICENSE NUMBER (required)
APPLICATION DATE
RESIDENCE ADDRESS (STREET)
CITY
STATE
ZIP CODE
COUNTY
MAILING ADDRESS (IF DIFFERENT)
CITY
STATE
ZIP CODE
COUNTY
DRIVER RECORD CERTIFICATION
During the 2-year period immediately preceding this date:
 Have you had more than one license (except for a military license)? …………………………………………………………….
YES
NO
 Has your license been suspended, revoked, cancelled or disqualified in this or any state? ……………………………………
YES
NO
Have you been convicted of any violations described below in any type of motor vehicle?
 Being under the influence of alcohol as prescribed by state law …………………………………………………………………
YES
NO
 Being under the influence of a controlled substance ………………………………………………………………………………
YES
NO
 Having an alcohol concentration of 0.04 or greater while operating a CMV …………………………………………………….
YES
NO
 Refusing to take an alcohol test as required by a State jurisdiction under its implied consent laws or regulations as defined
YES
NO
in 49 CFR 383.72 ………………………………………………………………………………………………………………………
 Leaving the scene of an accident …………………………………………………………………………………………………….
YES
NO
 Using the vehicle to commit a felony (other than manufacturing, distributing or dispensing a controlled substance) ………
YES
NO
 Driving a CMV while your CDL is revoked, suspended, cancelled; or you are disqualified from operating a CMV …………
YES
NO
 Causing a fatality through the negligent operation of a CMV (including motor vehicle manslaughter, homicide by motor
YES
NO
vehicle, or negligent homicide) ……………………………………………………………………………………………………….
 Using the vehicle in the commission of a felony involving manufacturing, distributing, or dispensing a controlled substance
YES
NO
Have you had more than one conviction for any of the violations described below in any type of motor vehicle?
 Speeding in excess of 15 mph or more above the posted speed limit …………………………………………………………..
YES
NO
 Driving recklessly, as defined by State or local law or regulation (including offenses of driving a motor vehicle in willful or
YES
NO
wanton disregard for the safety of persons or property) …………………………………………………………………………..
 Making improper or erratic lane changes …………………………………………………………………………………………..
YES
NO
 Following the vehicle ahead too closely ……………………………………………………………………………………………
YES
NO
 Violating State or local law relating to motor vehicle traffic control (other than a parking violation) arising in connection with
YES
NO
a fatal accident …………………………………………………………………………………………………………………………
 Driving a CMV without obtaining a CDL …………………………………………………………………………………………….
YES
NO
 Driving a CMV without a CDL in the driver’s possession …………………………………………………………………………
YES
NO
 Driving a CMV without the proper class of CDL and/or endorsements for a specific vehicle group being operated or for the
YES
NO
passengers or type of cargo being transported ……………………………………………………………………………………
 Violating a State or local law or ordinance on motor vehicle traffic control prohibiting texting while driving …………………
YES
NO
 Violating a State or local law or ordinance on motor vehicle traffic control restricting or prohibiting the use of a hand held
YES
NO
mobile telephone while driving ………. ……………………………………………………………………………………………..
Have you had any conviction for a violation of military, state or local law relating to motor vehicle traffic control
(other than parking violation) arising in connection with any traffic accident and have no record of an accident in
which you were at fault? …………………………………………………………………………………………………………..
NO
YES
CERTIFICATION OF DRIVING EXPERIENCE
Have you been regularly employed or were you regularly employed within the past year (12 months) in a military position
YES
NO
requiring the operation of a military motor vehicle that was representative of a commercial motor vehicle (CMV)?……………….
Were you exempted from the CDL licensing requirements for driving a military vehicle on state roads and highways in
YES
NO
accordance with 49 CFR §383.3 (c)? ……………………………………………………………………………………………………
Have you operated a military motor vehicle representative of the commercial motor vehicle (CMV) that you operate or expect
YES
NO
to operate, for at least the 2 years immediately preceding discharge from the military? …………………………………………
I certify under penalty of perjury that the information on this form is true and correct to the best of my knowledge, information and belief.
APPLICANT’S SIGNATURE
DATE
T21895-0814

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