Fillable Form Dts 33a - School License Application (Page 2 of 2) in pdf

Form Dts 33a - School License Application Page 2

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DTS 33A (08/10/2012)

SCHOOL OPERATIONS INFORMATION

THURSDAY

SATURDAY

MONDAY

TUESDAY

WEDNESDAY

FRIDAY

SUNDAY

BUSINESS HOURS

____AM to____PM

(8 hrs. minimum /week

CLASSROOM

____AM to____PM

____AM to____PM ____AM to____PM

____AM to____PM

HOURS

TRAINING SITE LOCATIONS

ATTACH THE FOLLOWING FOR EACH ADDITIONAL LOCATION

Copy of contract or agreement with expiration date authorizing the use of the facility to conduct

classroom/range instruction

DMV USE ONLY

Business License (if applicable)

DATE

NAME AND ADDRESS OF ADDITIONAL FACILITY

ADDED

REMOVED

CERTIFICATION (all owners must sign)

I/we apply for a original or renewal Driver Training School License and certify that all facts contained in this application are true and valid. I/we understand

that I/we must submit a National Criminal Records Check within 60 days of the submission of this application.

If licensed, it is understood that I/we are subject to current statutes and regulations pertaining to the operation of the school(s) and are subject to pre-

licensing, initial and annual audits by DMV.

I/we certify that I/we will use a curriculum approved by the Department of Motor Vehicles that includes state motor vehicle laws and federal motor carrier

safety rules and regulations. Additionally the curriculum will be in accordance with the curriculum guidelines for Driver Education in Virginia and current

statutes and regulations pertaining to motor vehicles and the operation of the school(s).

I/we further certify and affirm that all information presented in this form is true and correct, that any documents I/we have presented to DMV are genuine,

and that the information included in all supporting documentation is true and accurate. I/we make this certification and affirmation under penalty of perjury

and I/we understand that knowingly making a false statement or representation on this form is a criminal violation.

OWNER SIGNATURE

DATE

OWNER NAME

DATE

OWNER NAME

OWNER SIGNATURE

OWNER NAME

OWNER SIGNATURE

DATE

OWNER NAME

OWNER SIGNATURE