Form 40-5122 "Travel License / Identification Application" - Arizona

What Is an Arizona Driver's License Application?

Form 40-5122, Driver License/Identification Card Application, is an official document used in Arizona State to apply for either a Drivers License (DL), Commercial Drivers License (CDL), Instruction Permit (for new drivers), or an Identification Card (ID). There are options for travel (the travel DL, CDL, or an ID may be used as your main identification for air travel in the US) on non-travel DL, CDL, or an ID.

Alternate Name:

  • Arizona Drivers License Application.

Form 40-5122 is issued by the Arizona Department of Transportation with its most recent version released on February 1, 2020. A fillable Arizona Drivers License Application Form is available for download below.

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Arizona Drivers License Instructions

To apply for an Arizona Driver's License you will need to provide personal information. The ADOT (Arizona Department of Transportation) will need an applicant's full name and mailing address, phone number (optional), and SSN (your Social Security Number).

  1. Check the appropriate box if you had an Arizona state DL, CDL, or an ID issued before.
  2. You will also need to provide any medical information that can restrict your ability to drive as well as information about certain medical conditions that allow you to operate but need to be stated in your DL or ID card.
  3. The ADOT will also ask if you take any medication that may affect your ability to safely operate a motor vehicle.
  4. One of the optional boxes you may check if you would like to have your voting preferences updated on your file.
  5. Check the Organ/Tissue DONOR box if you wish to become an organ and tissue donor in the case of your accidental death.
  6. If you are a U.S. Military veteran and have a valid proof of service, you may have the word VETERAN put on your license.
  7. An Arizona Drivers License Application needs to be signed by the applicant (to certify that all the information given is true) and dated. In most cases, a DL, CDL, or an ID card are issued the same day. Instruction Permits are issued after the test is passed.
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Download Form 40-5122 "Travel License / Identification Application" - Arizona

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TRAVEL LICENSE / IDENTIFICATION APPLICATION
Clear
What are you applying for?
40-5122 R02/20
azdot.gov
Driver License
Identification Card
Commercial License
Permit (Not For Federal Identification)
CDL Permit (Not For Federal Identification)
Motorcycle
Contact Number
(optional)
(
)
Have you ever had a DL/ID issued in Arizona?
Yes
Social Security Number
Applicant Name (First, Middle, Last)
Suffix
(Apt / Unit #) City
State
Zip
Residence Street Address
(Apt / Unit #) City
State
Zip
Mailing Address (if different from above)
Appear on license
Sex
Height (Ft/In)
Date of Birth (Month/Day/Year)
Weight (lbs)
Eye Color
Hair
Female
Male
Voter Registration: Do you want to register to vote or update your voter registration and do you meet all the following eligibility requirements? (1) I am a
U.S. citizen; (2) I am an Arizona resident; (3) I will be at least 18 years old by the next general election; (4) I have NOT been convicted of a felony (or had
my civil rights restored); and (5) I have NOT been found mentally incapacitated with my voting rights revoked.
To vote in the next election, you must register at least 29 days before the election. The place where you register, or your decision not to register, will be
kept confidential. Submitting a false voter registration is a class 6 felony.
 YES, register me to vote or update my registration. By signing below, I swear or affirm that I meet all eligibility requirements listed above.
1.  I want to be placed on the Permanent Early Voting List (PEVL) and receive an early ballot by mail for each election I am eligible for.
2. Party Preference:  Republican  Democrat  Other
 None/No Party
 NO, do not use this information for voter registration.
1.  DONOR♥ I check this box to become an organ/tissue donor and join the DonateLifeAZ Registry. DONOR♥ will print on my license.
2.  I am a U.S. Military veteran who was enlisted, drafted, inducted or commissioned to serve in the active military, naval, or air service and I was not
dishonorably discharged. I would like the word “VETERAN” printed on my license/ID. (Proof Required)
3.  I have a medical condition that I want displayed on my license/ID. (Proof Required)
4. Do you have a physical, psychological or visual condition (other than wearing corrective lenses), or alcohol/drug dependency or are you currently
taking any medications that could affect your ability to safely operate a motor vehicle?  YES
Please Explain
5. Have you ever been determined to be incapacitated by a court?  YES
6. (Optional) Do you consent to the release of personal information contained in your driver license and vehicle record? I understand that this is not a one-
time consent that applies only to a specific individual or organization, but is instead a general consent that applies to all requests from any and all
individuals or organizations for any purpose, until revoked by me in writing. (Consent for a vehicle record applies to all owners)  YES
CDL APPLICANT ONLY
States where you held any type of license in the last 10 years (CFR) 49 Section 384.206
 Non-Excepted Interstate: I certify that I operate, or expect to operate, in interstate commerce and that I meet the qualifications under 49 CFR 391. I
understand that I am required to obtain a medical examiner’s certificate according to 49 CFR 391.45.
 Non-Excepted Intrastate: I certify that I operate in intrastate commerce and therefore am subject to Arizona driver qualifications. I understand that I am
required to obtain a medical examiner’s certificate according to 49 CFR 391.45.
I do not want a Travel DL/ID (Federal REAL ID Act compliant credential). I understand that by checking this box, my license or ID will state
NOT FOR FEDERAL IDENTIFICATION across the top and cannot be used at airport security or to enter federal buildings, military bases or nuclear power
plants and might not be usable for other purposes.
All Applicants: I certify under penalty of perjury that the information above is true and correct. I understand that I must report a change of address or
name to MVD within 10 days. All Driver Applicants: I understand the laws, rules and regulations described in the Arizona Driver License Manual, and that
I must report to MVD in writing, within 10 days, any medical condition that develops or worsens that may affect my ability to safely operate a motor
vehicle.
Social Security Number: You are required by A.R.S. §§ 28-3158(D)(4) and §§ 28-3165(F), under authority of 42 U.S.C. §§ 405(c)(2)(C) and
§ 666 (a)(13)(A), to provide your Social Security Number. It will be used to verify your identity and to comply with federal and state child support
enforcement laws. It will not be used as your driver license or identification card number.
Male Applicants Under 26: By submitting this application, I consent to registration with the Selective Service System if I am required to register under
federal law. If I am under 18, I understand that I will be registered as required by federal law when I become 18.
Applicant Signature
Notary Stamp
Acknowledged before me this date. Notary or MVD Agent Signature & RACF
Date
County
State
Commission Expires
(notary only)
TRAVEL LICENSE / IDENTIFICATION APPLICATION
Clear
What are you applying for?
40-5122 R02/20
azdot.gov
Driver License
Identification Card
Commercial License
Permit (Not For Federal Identification)
CDL Permit (Not For Federal Identification)
Motorcycle
Contact Number
(optional)
(
)
Have you ever had a DL/ID issued in Arizona?
Yes
Social Security Number
Applicant Name (First, Middle, Last)
Suffix
(Apt / Unit #) City
State
Zip
Residence Street Address
(Apt / Unit #) City
State
Zip
Mailing Address (if different from above)
Appear on license
Sex
Height (Ft/In)
Date of Birth (Month/Day/Year)
Weight (lbs)
Eye Color
Hair
Female
Male
Voter Registration: Do you want to register to vote or update your voter registration and do you meet all the following eligibility requirements? (1) I am a
U.S. citizen; (2) I am an Arizona resident; (3) I will be at least 18 years old by the next general election; (4) I have NOT been convicted of a felony (or had
my civil rights restored); and (5) I have NOT been found mentally incapacitated with my voting rights revoked.
To vote in the next election, you must register at least 29 days before the election. The place where you register, or your decision not to register, will be
kept confidential. Submitting a false voter registration is a class 6 felony.
 YES, register me to vote or update my registration. By signing below, I swear or affirm that I meet all eligibility requirements listed above.
1.  I want to be placed on the Permanent Early Voting List (PEVL) and receive an early ballot by mail for each election I am eligible for.
2. Party Preference:  Republican  Democrat  Other
 None/No Party
 NO, do not use this information for voter registration.
1.  DONOR♥ I check this box to become an organ/tissue donor and join the DonateLifeAZ Registry. DONOR♥ will print on my license.
2.  I am a U.S. Military veteran who was enlisted, drafted, inducted or commissioned to serve in the active military, naval, or air service and I was not
dishonorably discharged. I would like the word “VETERAN” printed on my license/ID. (Proof Required)
3.  I have a medical condition that I want displayed on my license/ID. (Proof Required)
4. Do you have a physical, psychological or visual condition (other than wearing corrective lenses), or alcohol/drug dependency or are you currently
taking any medications that could affect your ability to safely operate a motor vehicle?  YES
Please Explain
5. Have you ever been determined to be incapacitated by a court?  YES
6. (Optional) Do you consent to the release of personal information contained in your driver license and vehicle record? I understand that this is not a one-
time consent that applies only to a specific individual or organization, but is instead a general consent that applies to all requests from any and all
individuals or organizations for any purpose, until revoked by me in writing. (Consent for a vehicle record applies to all owners)  YES
CDL APPLICANT ONLY
States where you held any type of license in the last 10 years (CFR) 49 Section 384.206
 Non-Excepted Interstate: I certify that I operate, or expect to operate, in interstate commerce and that I meet the qualifications under 49 CFR 391. I
understand that I am required to obtain a medical examiner’s certificate according to 49 CFR 391.45.
 Non-Excepted Intrastate: I certify that I operate in intrastate commerce and therefore am subject to Arizona driver qualifications. I understand that I am
required to obtain a medical examiner’s certificate according to 49 CFR 391.45.
I do not want a Travel DL/ID (Federal REAL ID Act compliant credential). I understand that by checking this box, my license or ID will state
NOT FOR FEDERAL IDENTIFICATION across the top and cannot be used at airport security or to enter federal buildings, military bases or nuclear power
plants and might not be usable for other purposes.
All Applicants: I certify under penalty of perjury that the information above is true and correct. I understand that I must report a change of address or
name to MVD within 10 days. All Driver Applicants: I understand the laws, rules and regulations described in the Arizona Driver License Manual, and that
I must report to MVD in writing, within 10 days, any medical condition that develops or worsens that may affect my ability to safely operate a motor
vehicle.
Social Security Number: You are required by A.R.S. §§ 28-3158(D)(4) and §§ 28-3165(F), under authority of 42 U.S.C. §§ 405(c)(2)(C) and
§ 666 (a)(13)(A), to provide your Social Security Number. It will be used to verify your identity and to comply with federal and state child support
enforcement laws. It will not be used as your driver license or identification card number.
Male Applicants Under 26: By submitting this application, I consent to registration with the Selective Service System if I am required to register under
federal law. If I am under 18, I understand that I will be registered as required by federal law when I become 18.
Applicant Signature
Notary Stamp
Acknowledged before me this date. Notary or MVD Agent Signature & RACF
Date
County
State
Commission Expires
(notary only)
MVD AGENT – Vision Results
Passed Vision Exam – YES 
or Passed Daylight Restriction Vision Exam – YES 
- Corrective Lens  – MVD Agent RACF
Legal Guardian Certificate
Notary Stamp
For under 18 license/permit applicants
Initial one of the boxes that applies to your relationship with the applicant:
1. Natural/Adoptive parent, married to other natural/adoptive parent (Initial) __________
2. Natural/Adoptive parent with sole custody (Initial) __________
3. Natural/Adoptive parents share joint custody (Both parents signatures required) (Initial) __________
4. Full legal guardian (Initial) __________ (Proof required)
5. Other (Initial) __________ (Proof required)
Driving Practice Certificate
The applicant completed at least 30 hours of supervised driving practice, including at least 10 hours at night for a graduated driver
license; at least 30 hours of motorcycle riding practice for a motorcycle license or motorcycle endorsement.
(Initial) __________
I am responsible for any negligence or willful misconduct caused by the minor applicant.
Parent or Guardian Name
Parent or Guardian Name
Parent or Guardian Signature
Parent or Guardian Signature
Notary or MVD Agent Signature & RACF
Notary or MVD Agent Signature & RACF
Acknowledged before
Acknowledged before
me this date.
me this date.
Date
County
State
Commission Expires
Date
County
State
Commission Expires
(notary only)
(notary only)
MVD AGENT
Driving/MSF Certificate Submitted Date:
Re-Examination Skills Test
CDL Other
Rules of the Road
Date
GK
Air Brk Comb
H
N
P
S
T
MVD Agent
Date
MVD Agent RACF
 Pass
Date
GK
Air Brk Comb
H
N
P
S
T
MVD Agent
Motorcycle Knowledge Test
Date
GK
Air Brk Comb
H
N
P
S
T
MVD Agent
Date
MVD Agent RACF
 Pass
CDL Road/Skills Test
CCD #
Date
VIT
BCST
RT
MVD Agent
 Passed Parking
MVD AGENT RACF ____________
CCD#
Date
VIT
BCST
RT
MVD Agent
Road/Skills Test
CCD#
Date
VIT
BCST
RT
MVD Agent
Date
MVD Agent RACF
 Pass
MVD AGENT
Primary
Social Security Verification
Residency
Used OnBase/Base Record date: ___________ Used ONBASE Doc date: ___________
I certify that the documents used in order to establish this customers identity and eligibility have been verified and scanned into the
system.
MVD Agent Signature & RACF
Barcode Area
DO NOT COPY BARCODE
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