Commercial Driver'S License Application And Renewal Form

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STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DIVISION OF MOTOR VEHICLES
APPLICATION FOR COMMERCIAL
600 New London Avenue, Cranston, RI 02920-3024
DRIVER’S LICENSE (CDL-1)
Phone: 401-462-4368
NOTE: All CDL drivers must provide original proof of status as a U.S. Citizen or Lawful Permanent Resident when
doing any transaction beginning April 1, 2016.
Transaction Type (Select One)
License Class Information (Select Applicable Areas)
WHICH OF THE FOLLOWING ARE
CLASS COMMERCIAL LICENSE OR PERMIT APPLYING FOR:
YOU APPLYING FOR:
A (Combination Vehicles - GVWR 26,001 pound or more)
Do you intend to operate a vehicle
PERMIT (CLP)
B (Single Vehicles, GVWR 26,001 pounds or more)
equipped with air brakes?
LICENSE (CDL)
C (Single Vehicles, GVWR less than 26,001 pounds)
YES
NO
CDL ENDORSEMENT
ENDORSEMENTS:
H - HazMat
CDL CHANGE STATE-OF-RECORD
ALL CDL CLASSES REQUIRE A SKILLS TEST
(out-of-state transfer)
*
S - School Bus
Skills test are administered by the Community
CDL RENEWAL
College of Rhode Island. To book an
T - Double/Triple Trailers
appointment call 401-825-1146.
CDL DUPLICATE
* (16 or more persons, including driver)
P – Passenger
CDL UPDATE
N - Tank Vehicles
CDL UPGRADE
* Road test is required in addition to the written knowledge test to obtain the endorsement
Applicant’s Information (Complete All Fields)
LAST NAME:
FIRST NAME:
MIDDLE NAME:
DATE OF BIRTH:
GENDER:
SOCIAL SECURITY NUMBER:
PASSPORT/EMPLOYMENT AUTHORIZATION/RESIDENT
(MM/DD/YY)
ALIEN CARD NUMBER:
MALE
FEMALE
RI DRIVER’S LICENSE NUMBER:
CURRENT CLASS LICENSE:
A
B
C
10
ZIP CODE:
STREET ADDRESS:
APT/UNIT # or FLOOR #:
CITY/TOWN:
STATE:
RESIDENCE ADDRESS
STREET ADDRESS:
APT/UNIT # or FLOOR #:
CITY/TOWN:
ZIP CODE:
STATE:
MAILING ADDRESS (IF DIFFERENT FROM RESIDENCE)
TELEPHONE:
ACTIVE MILITARY:
100% DISABLED VETERAN:
VETERAN DESIGNATION:
(DD 214 MUST BE SHOWN,
(
)
YES
NO
YES
NO
YES
NO
STATING “HONORABLE DISCHARGE”)
Place Of Birth (Complete All Fields)
COUNTRY:
STATE/PROVINCE:
CITY:
Physical Information (Complete All Fields)
HEIGHT:
WEIGHT:
EYE COLOR:
(check one)
ft/in
lbs
HAIR COLOR:
(check one)
BROWN
GREEN
GRAY
DICHROMATIC
BLACK
BROWN
WHITE
BALD
RED
BLUE
BLACK
HAZEL
PINK
BLONDE
GRAY
Medical Certification
Medical Qualifications: Unless specifically exempted, you must possess a valid medical examiner’s certificate in order to operate a commercial motor vehicle
(49CFR 391.41). Government employees (e.g., federal, state, county or city employees) while operating government owned vehicles are exempt from this
medical requirement.
Self-Certification
You must determine what type of commerce you operate in. You must certify to the Division of Motor Vehicles (DMV) one (1) of the four (4) types of
commerce you operate in as listed below (select one):
1. Interstate Non-Excepted: You are an Interstate non-excepted driver and must meet the Federal DOT medical card requirements
(e.g., - you are “not excepted”).
2. Interstate Excepted: You are an Interstate excepted driver and do not have to meet the Federal DOT medical card requirements.
3. Intrastate Non-Excepted: You are an Intrastate non-excepted driver and are required to meet the medical requirements for your State.
4. Intrastate Excepted: You are an Intrastate excepted driver and do not have to meet the medical requirements for your State.
If you are subject to the DOT medical card requirements, please provide a new DOT medical to your DMV (located in Cranston) prior to the expiration of
the current DOT medical card.
rev. 1/17
CONTINUED ON BACK

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