Form Mv-523 - Application For Driving School Instructor Certificate (Page 2 of 2) in pdf

Applicant Name: _____________________________________________________

THE APPLICANT AGREES THAT:

1. If I end my employment with the driving school, I will surrender my instructor’s certificate to the school. (the school is required to

surrender the certificate to the DMV).

2. The instructor’s certificate will only be used to give driving and/or classroom instruction in the course of my employment with the driving

school identified on this application.

3. If I wish to be employed by an additional driving school, I understand that the school must submit an application for an additional

instructor’s certificate.

4. If my driver license is suspended or revoked, either temporarily or indefinitely, I understand that my instructor certificate will immediately

become void, and I must surrender my certificate to the driving school or DMV.

5. If I lose my certificate, I will report the loss to the local police in order to obtain a police report and have my employer submit a request for

a duplicate to DMV.

6. I will carry the instructor’s certificate at all times while giving driving instructions or when I am accompanying a student to a DMV road test.

I affirm that I have read this entire application; that I know its contents and that all answers, statements and all other matters contained in it are

true.

I understand that any false statement will result in the revocation of any driving school instructor’s certificate that has been

It is a criminal offense to knowingly make a false statement or conceal a material fact in this application. To do so will

issued to me. NOTE:

result in the revocation of your instructor certificate.

False statements are punishable under Section 210.45 of the Penal Code.

_________________________________________________________

Applicant’s Signature

Date

______________________

NAME AND ADDRESS OF LICENSED DRIVING SCHOOL SUBMITTING THIS APPLICATION:

This application must be signed by an authorized official of the driving school. My signature below affirms our intention to employ

this instructor to teach for our driving school.

ame of Driving School Official (printed) ___________________________________________________ Title_______________________

Signature of Driving

School Official

Date

___________________________________________________________________________

______________________

WHAT IS NEEDED: Find the section below that applies to the action you want to take. It lists the documents you must provide with

your completed application.

All applicable fees should be made payable to the “Commissioner of Motor Vehicles.”

ATTACH

Please note that “starter checks” cannot be accepted.

PHOTO

AN ORIGINAL INSTRUCTOR CERTIFICATE

A $10 check or money order payable to the Commissioner of Motor Vehicles - Fee is non-refundable.

Photograph must have been

A photograph no more than 30 days old

taken within past 30 days and

A copy of the applicant’s high school diploma or General Educational Development (GED) -

should be 1 7/8’’ wide x 2’’ long,

and must be a true likeness

NOTE:

Foreign documents must be translated by a Civil Service approved organization.

showing only the shoulders, neck

and uncovered head

A RENEWAL INSTRUCTOR CERTIFICATE

Send a

$20

check or money order payable to the Commissioner of Motor Vehicles

One photograph no more than 30 days old

Send proof of completion of the 30-Hour Basic Course for the preparation of professional driving school instruction .

(THE 30-HOUR BASIC COURSE MUST BE COMPLETED WITHIN A YEAR FROM THE DATE THE

ORIGINAL INSTRUCTOR CERTIFICATE IS/WAS ISSUED).

NOTE - if your driver license is NOT issued by New York State, or if you haven't completed the 30-Hour Basic Course, you can only

renew your certificate for one year. You must send a check/money order for $10 (one year renewal). If you are not licensed by

New York State, you must include an official abstract of your driver license record.

CLASSROOM ENDORSED INSTRUCTOR CERTIFICATE

Send a copy of the required 30-Hour Basic Course completion certificate.

Send proof of completing an approved advanced program in Teaching Techniques and Methodology.

(ONE YEAR OF BEHIND-THE-WHEEL INSTRUCTION WILL ALSO BE NECESSARY FOR CLASSROOM ENDORSEMENT)

Mail completed applications to: NYS Department of Motor Vehicles, Bureau of Driver Training Programs, 6 ESP, Room 221, Albany NY 12228.

PLEASE ALLOW 6-8 WEEKS FOR PROCESSING

MV-523 (3/17)

PAGE 2 OF 2

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Form Mv-523 - Application For Driving School Instructor Certificate Page 2

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