Form Cdl 10 is one of the most important forms that you will ever fill out as a truck driver. This form is used to report any accidents or incidents that occur while you are driving. Filling out this form accurately and promptly can help to ensure that any necessary investigations are carried out quickly and efficiently. In addition, accurate reporting can help to protect your commercial driving privileges. Make sure to familiarize yourself with the contents of Form Cdl 10 so that you can complete it correctly and avoid any penalties.
| Question | Answer |
|---|---|
| Form Name | Form Cdl 10 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | CDL 10 physical exemption p16 form |
CERTIFICATION OF PHYSICAL EXEMPTION 49 CFR PART 391/390
NOTICE:All information on this application must be in INK.
Certain uses of commercial vehicles exempt the driver from federal physical standards requiring a medical examiner’s certificate. However, the Texas medical standards for the issuance of a driver license still apply.
APPLICANT INFORMATION |
|
|
|
|
|
|
|||
LAST NAME |
|
|
|
|
FIRST NAME |
|
|
||
|
|
|
|
||||||
DATE OF BIRTH (mm/dd/yyyy) |
|
|
DRIVER LICENSE NUMBER |
|
|
|
|||
|
|
|
|
||||||
SOCIAL SECURITY NUMBER |
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|||
INSTRUCTIONS |
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
If you operate a commercial motor vehicle only in one of the capacities listed below, your commercial driver license will be restricted to the category(s) you select. Please review and select the applicable category(s) below.
CERTIFICATION
I certify that I:
a.Am at least 18 years of age, and
b.Am not disqualified to drive a motor vehicle in any state, and
c.Am exempt from the physical provisions of 49 CFR, Part 391/390 as I will operate a commercial motor vehicle only in the capacities I have checked below.
I further certify that I am exempt from the physical provisions of 49 CFR, part 391/390, and will operate a commercial motor vehicle only in the following capacity. Check the appropriate box(es).
1. School bus drivers employed by a private or parochial school and school bus drivers employed by a company that operates school buses under contract with a school are exempt from 49 CFR, Part 391/390, while transporting school children and/or school personnel from home to school and from school to home; or school bus drivers employed directly by a school district.
IF YOU HAVE SELECTED THIS EXEMPTION, YOU ARE REQUIRED TO UNDERGO AND PASS AN ANNUAL PHYSICAL EXAMINATION AS REQUIRED BY TEXAS TRANSPORTATION CODE SECTION 521.022 AND KEEP IN YOUR POSSESSION A CURRENT MEDICAL EXAMINER’S CERTIFICATE DURING THE OPERATION OF A SCHOOL BUS. A CURRENT MEDICAL EXAMINER’S CERTIFICATE IS NOT REQUIRED TO BE PRESENTED FOR THE ISSUANCE OR RENEWAL OF YOUR CDL.
2. Transportation performed by the Federal Government, a state, or any political subdivision of a state, or any agency established under a compact between states that has been approved by the Congress of the United States.
3. The occasional transportation of personal property by individuals not for compensation nor in the furtherance of a commercial enterprise;
4. The transportation of human corpses or sick and injured persons;
5. The private transportation of passengers;
6. Persons operating fire trucks and rescue vehicles while involved in emergency and related operations. (These are persons not exempted from CDL because they are not an employee of a political subdivision nor are they volunteer fire fighters);
7. Intracity zone drivers with limited exception from 49 CFR Parts 391/390 who possess a DOT medical examiner’s certificate restricted to intracity operation, where the driver must have been qualified to operate and operated a commercial motor vehicle in a municipality or exempt intracity zone thereof through the
8. The transportation of farm machinery, supplies, or both to or from a farm for
9. Drivers operating motor vehicles controlled and operated by a beekeeper engaged in the seasonal transportation of bees.
(OVER)
I CERTIFY THAT I OPERATE OR EXPECT TO OPERATE A COMMERCIAL MOTOR VEHICLE IN INTERSTATE COMMERCE. I ENGAGE OR WILL ENGAGE EXCLUSIVELY IN TRANSPORTATION OR OPERATIONS EXCEPTED UNDER 49 CFR 390.3(F), 391.2, 391. 8
OR 398.3 FROM ALL OR PARTS OF THE QUALIFICATION REQUIREMENTS OF 49 CFR PART 391. I MEET THE REQUIREMENTS OF CATEGORY 2, EXCEPTED INTERSTATE.
APPLICANT’S SIGNATURE
DATE
Sworn to and subscribed before me on this the |
|
day of |
|
, |
Notary Public or Authorized Officer
FOR DEPARTMENT USE ONLY
This form requires one of the following restrictions to be placed on the commercial driver license.
Box 1 requires P16 – If cmv, school buses (interstate)
Box 2 requires P17 – If cmv, governmental vehicles (interstate)
Box 3 requires P18 – If cmv, only transporting personal property (interstate)
Box 4 requires P19 – if cmv, transporting corpse/sick/injured (interstate)
Box 5 requires P20 – if cmv, privately transporting passengers (interstate)
Box 6 requires P21 – if cmv, fire/rescue (interstate)
Box 7 requires P22 – if cmv,
Box 8 requires P23 – if cmv, custom harvesting (interstate)
Box 9 requires P24 – if cmv, transporting bees/hives (interstate)
CLASS A – Texas Commercial Rules, General Knowledge, Combination,
CLASS B – Texas Commercial Rules, General Knowledge,
CLASS C – General Knowledge and any necessary endorsement exams