Form Dtp-424 - Certification Of Driving School Instructor Test Results
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1Bureau of Driver Training Programs
CERTIFICATION OF DRIVING SCHOOL INSTRUCTOR TEST RESULTS
Driving School Name:
Address:
I certify that ____________________________________________________________ , whose driver license number is
(Print Applicant’s Name)
________________________ has completed the Driving School Instructor Testing as indicated below:
(Applicant’s Driver License Number)
RESULTS OF EXAMINATIONS (Pass/Fail)
(indicate all tests and all results)
INITIALS
of Instructor
Instructor’s
Examination
Date
Result
Administering Test
Certificate Number
st
1
Written:
Pass
Fail
nd
2
Written:
Pass
Fail
st
1
Road Sign:
Pass
Fail
nd
2
Road Sign:
Pass
Fail
*
Pass
Fail
BTW Road Test
*Only one road test per application per vehicle type.
Submit originals of all test documents along with this form.
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(Signature of Applicant)
(Date)
The test(s) were administered in accordance with the rules, regulations, and procedures of the Department of Motor
Vehicles by _______________________________________________________________________________________,
(Print Name of Instructor)
who is employed by the driving school named above.
I have reviewed the instructor applicant’s driving record and find that s/he has at least two years of recent licensed experience.
If the applicant holds an out-of-state license, please attach a certified abstract of the driver license record.
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(Signature of Self-Certified Instructor)
(Date)
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(Signature of School Owner or Authorized Official)
(Date)
(
)
Telephone Number of School Owner/Authorized Official:
ext.
NOTE: Part 76.23(a)(5) of Commissioner Regulations authorizes the Department of Motor Vehicles to suspend or
revoke a driving school license for “the failure of the licensee or any partner, officer, agent or employee
of the licensee to conduct the prescribed tests for instructor applicants in the manner authorized by this
department and/or the failure of the licensee or any partner, officer, agent or employee of the licensee to
conduct the 30-hour course to instructor applicants according to the curriculum supplied by this
department and/or for the number of hours required by this department and this Part”.
dmv.ny.gov
DTP-424 (2/15)
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