Form Cdl-002 - Application For Commercial Driving Privileges Page 2
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1
2DRIVER SELF-CERTIFICATION (NAC 483 & 49 CFR 383.71)
Choose one:
:
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INTERSTATE –
May operate inside or outside Nevada
EXCEPTED
– Medical Examination NOT Required
INTRASTATE –
Restricted to operating within the borders of Nevada
NON-EXCEPTED
– Medical Examination Required
ENDORSEMENTS
(Learner permits may only contain a P, N and/or S endorsement)
Operate an autonomous vehicle in autonomous mode. Must also complete form DP-019, “Autonomous Vehicle Endorsement
G
Application.”
In Class C vehicle, may tow a vehicle (GVWR) or a combination of vehicles (GCWR) of more than 10,000 pounds. The
J
combination of vehicles may not exceed 70 feet in length or have a combined weight rating or a combined weight that exceeds
26,000 lbs. If the combination of the towing vehicle and the towed vehicle(s) exceeds 26,000 lbs., a Class A license is required.
Hazardous Material (HME) – Operate a vehicle transporting hazardous materials requiring placarding as defined by USDOT
H
regulations. A Transportation Security Administration (TSA) background check is required before an HME endorsement is issued.
Tank – Operate a vehicle designed to transport any liquid or gaseous materials within a tank or tanks having an individual rate
N
capacity of more than 119 gallons and an aggregate rated capacity of 1,000 gallons or more that is permanently or temporarily
attached to the vehicle or chassis
P
Passenger – Operate a vehicle designed to transport 16 or more occupants, including the driver
S
School Bus – Operate a school bus
T
Doubles/Triples – Operate a vehicle referred to as a double or a triple
Combined Tanker and Hazmat – Issued to a driver who qualifies for both tankers and hazardous materials (N and H
X
endorsements)
Affidavits and Signatures Must be Witnessed by an Authorized DMV Representative
INITIAL
AFFIDAVIT
LEARNER PERMIT
I, the undersigned, do hereby certify that I understand my learner permit is valid for up to 180 days from date of issuance
and I must carry it with me when I am driving. I understand the restrictions on my permit and agree to follow them.
DISCLOSURE STATEMENTS
• The Privacy Act of 1974 is a federal law that authorizes use of your Social Security Number to verify identity. You are required to
submit your Social Security Number so the state may administer laws related to licensing drivers (NRS 483.290).
• The driver’s license application you are submitting will cause any driving record from your previous state to be transferred to Nevada.
Due to your change of residency, the license or identification card in your previous state will show as surrendered.
•
NRS 482.385 requires you to register each vehicle you own and operate now or within 30 days of becoming a resident.
•
A CDL holder may not hold a Medical Marijuana Patient ID card.
I hereby certify, under penalty of perjury, that all statements in this application are true and correct. I understand that any and all
other driver’s license or identification cards issued by any other jurisdiction will be surrendered upon issuance of a Nevada
license or identification card. I agree and understand that any misstatement of material facts may cause cancellation and/or
denial of my license or identification card under NRS 483.420 and NRS 483.530, respectively. I further understand that any
misstatement of facts may be a misdemeanor or felony under NRS 483.530 and may be punishable pursuant to NRS 193.130.
Applicant Signature
Date
Sworn Before Me This
Day of
, 20
Authorized DMV Representative ______________________________________________ Tech ID _________________
Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this form once signed.
CDL-002 (Rev. 10/2015)
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