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- "Driving Certification Form for Maryland Commercial Driver's License Holders" - Maryland
"Driving Certification Form for Maryland Commercial Driver's License Holders" - Maryland
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.
Download "Driving Certification Form for Maryland Commercial Driver's License Holders" - Maryland
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1Maryland 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
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Most Popular Documents
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DA Form 2062 "Hand Receipt/Annex Number"
-
DD Form 2977 "Deliberate Risk Assessment Worksheet"
-
DA Form 31 "Request and Authority for Leave"
-
DD Form 1750 "Packing List"
-
IRS Form W-2 "Wage and Tax Statement"
-
DD Form 1351-2 "Travel Voucher or Subvoucher"
-
DA Form 3595 "Record Fire Scorecard"
-
DD Form 2923 "Privacy Act Data Cover Sheet"
-
DD Form 2813
-
DD Form 2656 "Data for Payment of Retired Personnel"
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- Washington State Patrol Inspection Request Form Washington State Patrol Inspection Request Form
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