Form Cdl-002 - Application For Commercial Driving Privileges
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1
2APPLICATION FOR COMMERCIAL DRIVING PRIVILEGES
ORIGINAL
RENEWAL DUPLICATE
LEARNER PERMIT
Information in boxes MUST be completed prior to visiting a DMV representative. Please PRINT in black or blue ink only.
LICENSE OR PERMIT
CLASSIFICATION
ENDORSEMENTS
(
)
SEE REVERSE SIDE FOR DESCRIPTIONS
Real ID
Class A
Class C
CDL
H
P
T
NCDL
G
Standard
Class B
Class M
N
S
X
J
NAME
ADDRESS
DATE OF BIRTH
SOCIAL SECURITY NUMBER
SEX
CHANGE TO INFORMATION ON CARD:
LAST NAME (PRINT)
FIRST NAME
MIDDLE NAME
SUFFIX
NEVADA DL/DAC/ID NUMBER
SOCIAL SECURITY NUMBER
DATE OF BIRTH
FULL LEGAL NAME ON BIRTH CERTIFICATE
BIRTHPLACE (CITY & STATE OR COUNTRY)
DO NOT SCAN MY BIRTH CERTIFICATE
SEX (CIRCLE)
HEIGHT
WEIGHT
HAIR COLOR
EYE COLOR
MOTHER’S MAIDEN NAME
M
F
FT.
IN.
LBS.
PRIMARY PHYSICAL ADDRESS
MAILING ADDRESS (IF DIFFERENT FROM PHYSICAL ADDRESS)
CITY, STATE, ZIP CODE
CITY, STATE, ZIP CODE
DAYTIME PHONE NUMBER
EMAIL ADDRESS
(
)
ALL APPLICANTS MUST COMPLETE THIS SECTION
(IF ONLY SELF-CERTIFYING, SKIP TO BACK PAGE)
YES
NO
Would you like to register to vote or make changes to your current voter registration?
VOTER
If you are a U.S. citizen and already registered to vote in Nevada, this form will update your voter registration address
.
REGISTRATION
I do or I do not want my address updated for voter registration purposes.
OR ADDRESS
Did you move to a different county?
Yes
No If yes, you must submit a NEW voter registration application.
CHANGE
VOTER REGISTRATION APPLICATION NUMBER:
YES
NO
I declare myself an honorably discharged U.S. Armed Forces veteran and authorize the DMV to send
my personal information to the Department of Veterans Services to provide benefits information to me.
VETERAN
YES
NO
I have a U.S. Armed Forces honorable discharge and wish to have a veteran designation placed/retained
on my license. If your card does not already have a veteran designation, present proof of honorable discharge.
YES
NO
If you are a male at least 18 years of age and less than 26 years old, would you like to register with the
SELECTIVE
Selective Service? By registering, you will remain eligible for federal student loans, grants, benefits
SERVICE
relating to job training, most federal jobs and, if applicable, citizenship in the United States. If YES, initial here: ____________
YES
NO
Would you like to be an organ donor and have that information on your license?
ORGAN
DONOR
Would you like to donate $1 or more to the anatomical gift account? If so, how much?
$______________
In the past ten (10) years, I have held a driver’s license in these states: _______________________________________________________________
UNDER WHAT NAME WAS IT ISSUED?
YES NO
Have you ever had a driver’s license or identification card in another name?
YES NO
Have you ever had a driver’s license or identification card in another state?
What state? ______________________
YES NO
Is the card in your possession?
License No. _____________________
Class/Type _______ Expiration Date ___________________
YES NO
Has your driving privilege ever been revoked, suspended, canceled or denied?
If yes, State _____________ Date ______________ Reason ___________________________________________________________________________
YES NO
Do you have any disability, illness, missing extremity, or take any medication that could affect your driving ability?
If yes, please explain ___________________________________________________________________________________________________________
If you wish, some medical conditions may be indicated on your CDL. Form DLD7 must be completed by your physician.
- CONTINUED ON BACK -
Office Use Only
Vision Acuity:
Left
Both
Right
Ind. ID # ___________________________________
Written
With OR Without Correction:
20/___
20/___
20/___
MEC Exp Date __________________________
PDPS/CDLIS: Clear Hit W/D:_____ Cites:_____ 2
Drive
nd
Hit
TSA Exp Date _______________________________
State:_______________
DLN:_________________________
Score(s) __________
Restrictions ________________________________
Docs / Notes:______________________________________________________________
Document Validation:
Issuance:
Initial
Renewal
_________________________________________________________________________
nd
2
Validation Completed
_________________________________________________________________________
Upgrade Transfer
Tech # and Initials: __________
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