Form DL 939 at a glance
What it is: The 10 YEAR HISTORY RECORD CHECK is a form of the State of California Department of Motor Vehicles.
Who signs: Sign on the line marked SIGNATURE X.
Complete this form if you are applying for or renewing a commercial driver license and you have been issued a driver license in the same or different name to operate any type of motor vehicle in another state or other jurisdiction during the previous ten years.
A filled-in Form DL 939 example: a renewal with two other-state licenses
How to fill out Form DL 939, box by box
Your CA driver license number and name
Under A, enter your CA Driver License Number and your Name (First, Middle, Last, Suffix (Jr., Sr., III) as shown on the Commercial Driver License Application DL 44C or Renewal Application.
Other state or jurisdiction licenses, boxes 1 to 15
Under B, Other State/Jurisdiction Driver License Information, for each license issued, complete all sections (even if same).
In each numbered box, enter the State/Country of Issuance, the Driver License Number, the Social Security Number, the Birth Date (MM/DD/YY), the Name (First, Middle, Last, Suffix (Jr., Sr., III) and the Sex.
Under Sex, mark Male or Female.
Signing the certification
Under C, by signing you understand that if it is determined that the information provided has been falsiied, the State may suspend, cancel, revoke your commercial driver license, or pending application, or disqualify you from operating a commercial motor vehicle for a period of at least 60 consecutive days. You certify (or declare) under penalty of perjury under the laws of the State of California that the information provided is true and correct.
Enter the date in DATE SIGN.
Sources
[1] Form DL 939 (REV. 11/2010), 10 Year History Record Check, California Department of Motor Vehicles (the Official source link on this page).