Form DS-870 "Article 19-a Bus Driver Application" - New York

What Is Form DS-870?

This is a legal form that was released by the New York State Department of Motor Vehicles - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2019;
  • The latest edition provided by the New York State Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DS-870 by clicking the link below or browse more documents and templates provided by the New York State Department of Motor Vehicles.

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Download Form DS-870 "Article 19-a Bus Driver Application" - New York

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ARTICLE 19-A BUS DRIVER APPLICATION
dmv.ny.gov
Complete all parts of this form. Please print or type.
Email or fax a copy to Bus Driver Unit at BusDriverUnit@dmv.ny.gov or (518) 474-0593.
Keep the original in your driver 19-A file. (Electronic carriers must keep original and 19-A receipt in driver file.)
DRIVER INFORMATION
Driver’s Last Name
First
M.I.
Date of Birth (Month/Day/Year)
Social Security Number
o
o
Male
Female
Street Address
City
State
Zip Code
County
Telephone Number
Class of Driver’s License Endorsements
Restrictions
Expiration Date
License ID Number
State
(from Driver License)
CARRIER INFORMATION
Carrier/DBA Name
Legal Name (if different)
Federal ID Number
19-A Business ID Number
Street Address
City
State
Zip Code
County
Telephone Number
Name of Article 19-A Contact Person
Title
Will this driver be a school bus driver per section
6.2(b) of the regulations of the Commissioner of
o
o
Motor Vehicles?
Yes
No
Driver must complete the following sections.
If nothing to report, enter “Not Applicable” in the following sections. Do not leave any blanks.
EMPLOYMENT (Start with your most recent employment, and include work history for the past 3 years):
What were the date(s) of your employment?
Employer Name and Address
Your job title
(From - To)
ACCIDENTS (Start with your most recent accident, and include accidents within the past 3 years):
Was there personal injury or property damage?
Location
If “YES”, indicate the dollar amount of damage to each
Date of Accident
(City, State, Zip Code, County)
What type of vehicle were you driving?
vehicle, and the number of people injured.
CONVICTIONS (Start with your most recent conviction, and include all criminal convictions):
Location
If a vehicle was involved, what type
Date of Violation
(City, State, Zip Code, County)
Date of Conviction
Of what charge were you convicted?
of vehicle were you driving?
DRIVER AFFIRMATION:
To the best of my knowledge, the information I have given on this application is true.
X
Date
Signature of Driver
EMPLOYER CERTIFICATION:
This application has been reviewed together with the driver abstract and medical examination (form DS-874 or
USDOT form 649-F or equivalent) and the applicant is hereby classified as a “conditional driver” as defined in Section 6.2(r) and in accordance
with the requirements of Sections 6.3 and 6.4 of the regulations of the Commissioner of Motor Vehicles. Final approval of employment is subject
to the applicant meeting the requirements of Article 19-A of the New York State Vehicle and Traffic Law. All questions pertaining to this form
and/or the Article 19-A Program should be directed to the Bus Driver Unit. By phone: (518) 473-9455; by email: busdriverunit@dmv.ny.gov.
X
Signature of Employer/Agent
Date
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DS-870 (1/20)
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ARTICLE 19-A BUS DRIVER APPLICATION
dmv.ny.gov
Complete all parts of this form. Please print or type.
Email or fax a copy to Bus Driver Unit at BusDriverUnit@dmv.ny.gov or (518) 474-0593.
Keep the original in your driver 19-A file. (Electronic carriers must keep original and 19-A receipt in driver file.)
DRIVER INFORMATION
Driver’s Last Name
First
M.I.
Date of Birth (Month/Day/Year)
Social Security Number
o
o
Male
Female
Street Address
City
State
Zip Code
County
Telephone Number
Class of Driver’s License Endorsements
Restrictions
Expiration Date
License ID Number
State
(from Driver License)
CARRIER INFORMATION
Carrier/DBA Name
Legal Name (if different)
Federal ID Number
19-A Business ID Number
Street Address
City
State
Zip Code
County
Telephone Number
Name of Article 19-A Contact Person
Title
Will this driver be a school bus driver per section
6.2(b) of the regulations of the Commissioner of
o
o
Motor Vehicles?
Yes
No
Driver must complete the following sections.
If nothing to report, enter “Not Applicable” in the following sections. Do not leave any blanks.
EMPLOYMENT (Start with your most recent employment, and include work history for the past 3 years):
What were the date(s) of your employment?
Employer Name and Address
Your job title
(From - To)
ACCIDENTS (Start with your most recent accident, and include accidents within the past 3 years):
Was there personal injury or property damage?
Location
If “YES”, indicate the dollar amount of damage to each
Date of Accident
(City, State, Zip Code, County)
What type of vehicle were you driving?
vehicle, and the number of people injured.
CONVICTIONS (Start with your most recent conviction, and include all criminal convictions):
Location
If a vehicle was involved, what type
Date of Violation
(City, State, Zip Code, County)
Date of Conviction
Of what charge were you convicted?
of vehicle were you driving?
DRIVER AFFIRMATION:
To the best of my knowledge, the information I have given on this application is true.
X
Date
Signature of Driver
EMPLOYER CERTIFICATION:
This application has been reviewed together with the driver abstract and medical examination (form DS-874 or
USDOT form 649-F or equivalent) and the applicant is hereby classified as a “conditional driver” as defined in Section 6.2(r) and in accordance
with the requirements of Sections 6.3 and 6.4 of the regulations of the Commissioner of Motor Vehicles. Final approval of employment is subject
to the applicant meeting the requirements of Article 19-A of the New York State Vehicle and Traffic Law. All questions pertaining to this form
and/or the Article 19-A Program should be directed to the Bus Driver Unit. By phone: (518) 473-9455; by email: busdriverunit@dmv.ny.gov.
X
Signature of Employer/Agent
Date
Become an Organ Donor! Visit donatelife.ny.gov
reset/clear
DS-870 (1/20)