Form Mv-526 - Driving School Instructor Termination Notice printable pdf download

Form Mv-526 - Driving School Instructor Termination Notice

DRIVING SCHOOL INSTRUCTOR

TERMINATION NOTICE

Bureau of Driver Training Programs

COMMISSIONER’S REGULATION Part 76.15(f) requires a driving school to: 1) notify the Department of Motor Vehicles of

the termination of an instructor’s employment; and 2) provide a copy of this termination notice to the instructor named below.

Instructions:

Complete this form and send it to: New York State Department of Motor Vehicles, Bureau of Driver Training

Programs, Certification & Oversight Unit, 6 Empire State Plaza, Room 221, Albany NY 12228.

Name and Address of School

Name and Address of Instructor

Instructor Certificate No. ____________________

Termination Date

______________________________

The number of hours accrued by this instructor in behind-the-wheel instruction while employed by this school

between ________________________ and ________________________ , is ____________________ hours.

Mo.

Day

Year

Mo.

Day

Year

Please Attach

Instructor’s Certificate

(MV-524)

Here

If the MV-524 is not attached, indicate why here:

I affirm that the above information is true. NOTE: It is a criminal offense to knowingly make a false statement or

conceal a material fact. False statements are punishable under Section 210.45 of the Penal Code.

(Signature of Driving School Owner or Authorized Official)

(Print/Type Name of Driving School Owner or Authorized Official)

(Date)

MV-526 (11/15)

reset/clear

Form Mv-526 - Driving School Instructor Termination Notice