Form 4008 - Application For Cdl Waiver For Farm-Related Service Industries

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Missouri Department of Revenue

Form

Application for CDL Waiver for

4008

Farm-Related Service Industries

The Commercial Driver License (CDL) waiver for farm-related service industries may be used by seasonal CDL drivers for farm retail outlets and suppliers,

agri-chemical businesses, custom harvesters, and livestock feeders. This waiver allows a seasonal driver to obtain a restricted Class B or Class C CDL license

without written or skills testing. The holder of a restricted CDL may operate a commercial motor vehicle only within a 150 mile radius of a place of business or

farm being served.

Name (Last, First, and Middle)

Previous Name, if Changed

Residence Address (Street)

City

State

Zip Code

County

Daytime Telephone Number

(

)

___ ___ ___

___ ___ ___ ___

Use the information from your current driver license to complete this section.

State of Issued License

License Class

Expiration Date (MM/DD/YYYY)

Endorsement(s)

Restrictions(s)

___ ___ / ___ ___ / ___ ___ ___ ___

Date of Birth (MM/DD/YYYY)

License Number

Sex

Height

Weight

Eye Color

___ ___ / ___ ___ / ___ ___ ___ ___

Select the box(es) that apply to your type of employment.

Agri-Chemical Business

Custom Harvester

Farm Retail Outlet or Supplier

Livestock Feeder

Select the box(es) that apply to the class(es) of vehicle(s) you drive.

r Class C (Restricted)

r Class B (Restricted)

A Class C Commercial Driver License (CDL) issued through the

A Class B Commercial Driver License (CDL) issued through the

Farm Related Services Industry Waiver Program, allows the holder

Farm Related Services Industry Waiver Program, allows the

to operate a single unit vehicle with a gross vehicle weight rating

holder to operate a single unit vehicle with a gross vehicle weight

(GVWR) of less than 26,001 pounds or any such vehicle towing a

rating (GVWR) of 26,001 or more pounds or any such vehicle

vehicle not in excess of 10,000 pounds GVWR.

towing a vehicle not in excess of 10,000 pounds GVWR.

Note: The holder of a Restricted Class B or C CDL issued through this waiver program is not allowed to transport passengers or hazardous materials

which require the vehicle to be placarded, with the exception of 1,000 gallons or less of diesel fuel, 3,000 gallons of liquid fertilizers, or any quantity of

solid fertilizers.

You must indicate the seasonal period below. The seasonal period cannot exceed 180 consecutive days in any 12 month period. A “U/Z Restriction Card”

bearing those dates will be mailed to you, which you must carry with your driver license.

Seasonal Period Start Date (MM/DD/YYYY):

Seasonal Period End Date (MM/DD/YYYY):

__ __ /__ __ /__ __ __ __

• I s your driving privilege currently suspended, revoked, cancelled, or disqualified in this or any other state? . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you held a driver license for at least one year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

During the two years before today’s date:

• Has your license been suspended, revoked, cancelled, or disqualified in this or any other state? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of driving a commercial motor vehicle while suspended, revoked, cancelled, or disqualified? . . . . . . . . . . . .

Yes

• Have you been convicted of causing a fatality through the negligent operation of a commercial motor vehicle? . . . . . . . . . . . . . . . . . .

Yes

Form 4008 (Revised 9-2013)