ARTICLE 19-A BUS DRIVER ADD/DROP NOTICE
dmv.ny.gov
Complete CARRIER INFORMATION.
Complete COLUMN A (ADDS) for any bus driver who is being rehired or reinstated with your company.
Complete COLUMN B (DROPS) for any bus driver who has left service with your company for any reason, or who is on a leave of absence
that will prevent you from keeping that driver’s 19-A records up-to-date, or who you have disqualified.
Please type or print the following information:
CARRIER INFORMATION
Carrier/DBA Name
Legal Name (if different)
Federal ID Number
19-A Business ID Number
City
State
Zip Code
Street Address
Name of Carrier Representative
Signature of Carrier Representative
Date
X
COLUMN A - ADDS
COLUMN B - DROPS
NOTE: If you are dropping a driver you disqualified because the driver
NOTE: If you are employing a bus driver for the first time, do not use
failed the 19-A biennial road test, biennial oral/written test, or
this form; use form DS-870, the Article 19-A Bus Driver
medical examination, you must check the “YES” box in the DRIVER
$pplication.
DISQUALIFIED field, indicate the reason for disqualification, and
attach a copy of the failed test or failed medical examination.
DRIVER’S LAST NAME
FIRST
M.I.
FIRST
M.I.
DRIVER’S LAST NAME
CLIENT ID NUMBER (from driver license) DATE OF BIRTH
STATE OF
CLIENT ID NUMBER (from driver license) DATE OF BIRTH
STATE OF
LICENSE
LICENSE
EFFECTIVE DATE DRIVER REINSTATED
EFFECTIVE DATE OF DROP
DRIVER’S LAST NAME
FIRST
M.I.
DRIVER DISQUALIFIED
REASON FOR DISQUALIFICATION
YES
CLIENT ID NUMBER (from driver license) DATE OF BIRTH
STATE OF
NO
LICENSE
EFFECTIVE DATE DRIVER REINSTATED
DRIVER’S LAST NAME
FIRST
M.I.
DRIVER’S LAST NAME
FIRST
M.I.
CLIENT ID NUMBER (from driver license) DATE OF BIRTH
STATE OF
CLIENT ID NUMBER (from driver license) DATE OF BIRTH
STATE OF
LICENSE
LICENSE
EFFECTIVE DATE DRIVER REINSTATED
EFFECTIVE DATE OF DROP
DRIVER’S LAST NAME
FIRST
M.I.
REASON FOR DISQUALIFICATION
DRIVER DISQUALIFIED
YES
CLIENT ID NUMBER (from driver license) DATE OF BIRTH
STATE OF
NO
LICENSE
EFFECTIVE DATE DRIVER REINSTATED
DRIVER’S LAST NAME
FIRST
M.I.
DRIVER’S LAST NAME
FIRST
M.I.
CLIENT ID NUMBER (from driver license) DATE OF BIRTH
STATE OF
CLIENT ID NUMBER (from driver license) DATE OF BIRTH
STATE OF
LICENSE
LICENSE
EFFECTIVE DATE DRIVER REINSTATED
EFFECTIVE DATE OF DROP
DRIVER’S LAST NAME
FIRST
M.I.
DRIVER DISQUALIFIED
REASON FOR DISQUALIFICATION
YES
CLIENT ID NUMBER (from driver license) DATE OF BIRTH
STATE OF
NO
LICENSE
EFFECTIVE DATE DRIVER REINSTATED
PLEASE SUBMIT THE ORIGINAL COMPLETED COPY OF THIS FORM TO: New York State Department of Motor Vehicles, Bus Driver
Unit, 6 Empire State Plaza, Rm 136B, Albany, New York 12228. In addition, you are required to keep a copy of completed form DS-885 in
THE BUS DRIVER UNIT MUST RECEIVE THIS FORM WITHIN
your drivers’ 19-A files.
10 DAYS OF THE EFFECTIVE DATE LISTED ABOVE.
Clear Form
DS-885 (6/15)
Clear Form