Form R-390 "Annual Report of Appointment of School Bus Safety Coordinator" - Connecticut

What Is Form R-390?

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

Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the Connecticut 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 R-390 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Motor Vehicles.

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Download Form R-390 "Annual Report of Appointment of School Bus Safety Coordinator" - Connecticut

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ANNUAL REPORT OF APPOINTMENT OF
SCHOOL BUS SAFETY COORDINATOR
R-390 Rev. 10-2018
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
INSTRUCTIONS:
Complete entire report - one for each coordinator, please print or type
1.
Send to DMV prior to commencement of the school year
2.
Report changes to DMV by mail within 10 days
3.
MAIL TO: DMV COMMERCIAL VEHICLE SAFETY DIVISION, 60 STATE STREET, ROOM 145, WETHERSFIELD CT 06161
PART I
SCHOOL YEAR:
TERM OF APPOINTMENT:
TYPE OF REPORT:
FROM:
TO:
FROM:
TO:
ANNUAL
CHANGE (Describe change)
NAME OF CARRIER/LOCAL-REGIONAL BOARD OF EDUCATION
FULL NAME OF AUTHORIZED CONTACT PERSON
BUSINESS STREET ADDRESS
FULL TITLE OF AUTHORIZED CONTACT PERSON
CITY/TOWN/STATE/POSTAL CODE
BUSINESS PHONE
CELL PHONE
MAILING ADDRESS IF DIFFERENT FROM BUSINESS ADDRESS
E-MAIL ADDRESS
FAX NO.
CITY/TOWN/STATE/POSTAL CODE
FULL NAME OF SAFETY COORDINATOR
PART II
FULL NAME OF SAFETY COORDINATOR
DATE OF BIRTH
IF CERTIFIED INSTRUCTOR, ID NO.
STREET ADDRESS (Home)
OPERATOR LIC. NO.
LAST PROF. TEST DATE (S ENDORS.)
MAILING ADDRESS IF DIFFERENT FROM STREET ADDRESS
LICENSE CLASS
ENDORSEMENTS
RESTRICTIONS
CITY/TOWN/STATE/POSTAL CODE
DAYTIME TELEPHONE NO.
E-MAIL ADDRESS
PART III
SIGNATURE OF AUTHORIZED CONTACT PERSON
DATE SIGNED
SIGNATURE OF SAFETY COORDINATOR
DATE SIGNED
SIGNATURE OF MASTER INSTRUCTOR
MI ID NO.
DATE SIGNED
PART IV - FOR DMV USE ONLY
DMV STAFF
DMV STAFF TITLE
APPROVAL GRANTED
DATE
YES
NO
REASON FOR DENIAL OF APPLICATION
ANNUAL REPORT OF APPOINTMENT OF
SCHOOL BUS SAFETY COORDINATOR
R-390 Rev. 10-2018
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
INSTRUCTIONS:
Complete entire report - one for each coordinator, please print or type
1.
Send to DMV prior to commencement of the school year
2.
Report changes to DMV by mail within 10 days
3.
MAIL TO: DMV COMMERCIAL VEHICLE SAFETY DIVISION, 60 STATE STREET, ROOM 145, WETHERSFIELD CT 06161
PART I
SCHOOL YEAR:
TERM OF APPOINTMENT:
TYPE OF REPORT:
FROM:
TO:
FROM:
TO:
ANNUAL
CHANGE (Describe change)
NAME OF CARRIER/LOCAL-REGIONAL BOARD OF EDUCATION
FULL NAME OF AUTHORIZED CONTACT PERSON
BUSINESS STREET ADDRESS
FULL TITLE OF AUTHORIZED CONTACT PERSON
CITY/TOWN/STATE/POSTAL CODE
BUSINESS PHONE
CELL PHONE
MAILING ADDRESS IF DIFFERENT FROM BUSINESS ADDRESS
E-MAIL ADDRESS
FAX NO.
CITY/TOWN/STATE/POSTAL CODE
FULL NAME OF SAFETY COORDINATOR
PART II
FULL NAME OF SAFETY COORDINATOR
DATE OF BIRTH
IF CERTIFIED INSTRUCTOR, ID NO.
STREET ADDRESS (Home)
OPERATOR LIC. NO.
LAST PROF. TEST DATE (S ENDORS.)
MAILING ADDRESS IF DIFFERENT FROM STREET ADDRESS
LICENSE CLASS
ENDORSEMENTS
RESTRICTIONS
CITY/TOWN/STATE/POSTAL CODE
DAYTIME TELEPHONE NO.
E-MAIL ADDRESS
PART III
SIGNATURE OF AUTHORIZED CONTACT PERSON
DATE SIGNED
SIGNATURE OF SAFETY COORDINATOR
DATE SIGNED
SIGNATURE OF MASTER INSTRUCTOR
MI ID NO.
DATE SIGNED
PART IV - FOR DMV USE ONLY
DMV STAFF
DMV STAFF TITLE
APPROVAL GRANTED
DATE
YES
NO
REASON FOR DENIAL OF APPLICATION
Sec. 14-275c-48
Appointment of a safety coordinator
(a)
Each carrier which is not an individual person shall appoint one or more safety coordinator(s) who
shall be responsible for carrying out the duties imposed on the carrier in accordance with the
requirements of Sections 14-275c-46 through 14-275c-53 of these regulations. The safety
coordinator(s) shall also serve as the carrier's contact person for the department with respect to
driving qualifications. Each carrier required to appoint a safety coordinator(s) shall report to the
commissioner annually in writing prior to the beginning of each school year the name, address and
telephone number of its safety coordinator(s), and shall notify the commissioner in writing of any
change in the information so reported.
Any local or regional board of education or other authority responsible for primary, secondary or
(b)
special education whose carriers are individual persons shall appoint a safety coordinator having the
same duties as specified in subsection (a) of this section. Each authority required to appoint a safety
coordinator shall report to the commissioner annually in writing prior to the beginning of each school
year the name, address and telephone number of the safety coordinator so appointed, and shall notify
the commissioner in writing of any change in the information so reported.
(Effective January 25, 1994)
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