"Driving Certification Form for Maryland Commercial Driver's License Holders" - Maryland

"Driving Certification Form for Maryland Commercial Driver's License Holders" - Maryland Download Pdf
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Driving Certification Form for Maryland Commercial Driver's License Holders is a legal document that was released by the Maryland Department of Transportation - a government authority operating within Maryland.

Form Details:

  • Released on May 6, 2013;
  • The latest edition currently provided by the Maryland Department of Transportation;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Maryland Department of Transportation.

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Maryland Motor Vehicle Administration
6601 Ritchie Highway, N.E.
Room 145, Attn: CDL Med Cert
Glen Burnie, MD 21062
Driving Certification for Maryland Commercial Driver’s License Holders
PLEASE READ AND COMPLETE.
Applicant Information (Please Print):
*Indicates a required field
*
*
Driver License Number
Date of Birth (Month/Day/Year)
Current Medical Certificate Expiration
*
Date (Month/Day/Year)
*
Middle Name
*
Suffix
First Name
Last Name
** You must provide either a
Contact Phone Number **
Contact Phone Number
or
Email
Address
Email Address **
Select one of the following four options:
Certification:
I am qualified to operate a commercial motor vehicle
*
Interstate and have a valid medical examiner’s certificate. (NI)
Intrastate (within MD) OR I am under the age of 21 OR I have an approved MVA CDL Medical Waiver. (NA)
Interstate and am exempt from obtaining a medical examiner’s certificate. (EI)
Intrast
Intrastate (within MD) and meet all applicable MD State requirements. (EA)
I certify, under penalty of perjury that the statements made by me on this application are true
and correct to the best of my knowledge, information and belief.
__________________________________
_________________________
Signature
Date
Revised 06May2013
Maryland Motor Vehicle Administration
6601 Ritchie Highway, N.E.
Room 145, Attn: CDL Med Cert
Glen Burnie, MD 21062
Driving Certification for Maryland Commercial Driver’s License Holders
PLEASE READ AND COMPLETE.
Applicant Information (Please Print):
*Indicates a required field
*
*
Driver License Number
Date of Birth (Month/Day/Year)
Current Medical Certificate Expiration
*
Date (Month/Day/Year)
*
Middle Name
*
Suffix
First Name
Last Name
** You must provide either a
Contact Phone Number **
Contact Phone Number
or
Email
Address
Email Address **
Select one of the following four options:
Certification:
I am qualified to operate a commercial motor vehicle
*
Interstate and have a valid medical examiner’s certificate. (NI)
Intrastate (within MD) OR I am under the age of 21 OR I have an approved MVA CDL Medical Waiver. (NA)
Interstate and am exempt from obtaining a medical examiner’s certificate. (EI)
Intrast
Intrastate (within MD) and meet all applicable MD State requirements. (EA)
I certify, under penalty of perjury that the statements made by me on this application are true
and correct to the best of my knowledge, information and belief.
__________________________________
_________________________
Signature
Date
Revised 06May2013
Maryland Mva Forms Maryland Department of Transportation Maryland Legal Forms Legal United States Legal Forms

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