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Form Sf-1438 - Tennessee Department Of Safety Supplemental - Application For Commercial Driver License Template

Instructions for Self-Certification

Attached is the supplemental application SF-1438 for a commercial driver license you are

to use for self-certification.

1. Date the form in the upper left corner.

2. Leave blank the application number and do not check the boxes below the date.

3. Print your Last Name, First Name and Middle Initial along with any suffix.

4. Print your Tennessee Commercial Driver License Number.

5. Print your Social Security Number.

6. Print your Date of Birth, Month, Day, Year (Example April 9, 1963- 04/09/1963)

7. Print the best daytime telephone number to reach you at.

8. You must certify to item 1, 2, 3, or 4, whichever is applicable by initialing the line

beside the number.

9. DO NOT fill out items 5,6,7 or 8 for this self certification.

10. Sign your name on the line above Applicant Signature

11. Write the date you sign the self-certification.

12. Please send this from along with a copy of your medical examiner’s certificate to:

Tennessee Department of Safety and Homeland Security

Commercial Driver License Division

1148 Foster Avenue

Nashville, TN 37243

You may fax this self-certification along with your medical examiner’s certificate to:

615-401-7674 or by email the scanned copies in a PDF format to:

DI.CDL.Medcert@tn.gov

In the event you have questions, please call 615-687-2312. If you call by telephone,

please have your commercial driver license number readily available.

Form Sf-1438 - Tennessee Department Of Safety Supplemental - Application For Commercial Driver License Template