Dl 170 Etp Form – Fill Out and Use This PDF

This certiicate is valid for one year from the drive test date. Return the original copy of this form to a Department of Motor Vehicles (DMV) ofice unless DMV tells you to mail it to Sacramento. Make a copy for your records. If you have questions, please call the Employer

Testing Program Unit at (916) 229-4404.

DRIVER COMPLETES THIS SECTION

PRINT DRIVER’S NAME		(First	Middle	Last)		DRIVER LICENSE NUMBER
ADDRESS				CITY	STATE	ZIP CODE
HOME TELEPHONE NUMBER			WORK TELEPHONE NUMBER		EMPLOYMENT DATE WITH THIS COMPANY (REQUIRED)
(	)		(	)	SINCE	MO_____ DA_____ YR_____

I certify under penalty of perjury under the laws of the State of California that the information I have provided is true and correct. I am employed by the employer named below, have attended driver training and have passed the employer’s driving test(s). I understand that I may be required to pass a DMV administered test, at DMV’s discretion. I also understand that if the employer’s drive test(s) does not meet DMV’s requirements and standards I will be required to retest or my commercial driver license will be downgraded to the previous class.

EXAMINER COMPLETES THIS SECTION

The driver passed a drive test(s) in the following type vehicle(s) on _________________________.

designed to carry 11–15 passengers, including the driver (Restriction 74 or 75)

designed to carry 16 or more passengers, including the driver, with a GVWR of 26,000 lbs. or less (Restriction 76) designed to carry 16 or more passengers, including the driver with a GVWR of 26,001 lbs. or more

The vehicle(s) used for this drive test(s):
has an automatic transmission (Restriction 64)	does not have air brakes (Restriction 48)
has an automated transmission (Restriction 65)	is equipped with air brakes (law test required)
has a manual transmission	is a 3-axle vehicle with a GVWR between 6,000–26,000 lbs.
	(Restriction 79—Class B vehicles only)

I certify under penalty of perjury under the laws of the State of California that the information I have provided is true and correct.

I have the appropriate class of commercial license for the test vehicle, and have administered a drive test(s) which meets DMV’s drive test requirements and standards in the vehicle(s) identiied above.

EXECUTED AT

CITY

COUNTY

EXAMINER’S SIGNATURE

DATE

	X
EXAMINER’S PRINTED NAME	DRIVER LICENSE NUMBER

EMPLOYER’S REPRESENTATIVE COMPLETES THIS SECTION

I certify under penalty of perjury under the laws of the State of California that the information I have provided is true and correct. I am an authorized representative of the employer shown on this form. The driver named above is employed by this employer and is required to operate Class A or Class B vehicles in the course of his or her employment. This driver has attended the required training, and passed a drive test(s) which meets DMV’s drive test requirements and standards.

EXECUTED AT

CITY

COUNTY

AUTHORIZED REPRESENTATIVE’S SIGNATURE

DATE

		X
AUTHORIZED REPRESENTATIVE’S PRINTED NAME		DRIVER LICENSE NUMBER			PHONE NUMBER WHERE REPRESENTATIVE CAN BE REACHED
					(	)		EXT.
EMPLOYER NAME
EMPLOYER ADDRESS		CITY					STATE	ZIP CODE
DMV FIELD OFFICE		DMV HEADQUARTERS USE ONLY
PLEASE NOTE: Send this form		HEADQUARTERS APPROVAL		PREVIOUS CLASS			CURRENT CLASS
directly to the Employer Testing
		CO. AUTHORIZATION AT TIME OF CERT.		PREVIOUS ENDORSEMENTS			CURRENT ENDORSEMENTS
Program Unit, M/S L224.
EMPLOYEE NAME, ID NUMBER, AND FO NUMBER				PREVIOUS RESTRICTIONS			CURRENT RESTRICTIONS
DL 170 ETP (REV. 9/2006) WWW

DRIVER

•This form is valid one year from the date of the drive test.

•If the drive test administered by your employer does not meet DMV requirements and standards, you may be required to retest to retain your commercial license status.

•You may be required to pass a DMV administered test at DMV’s discretion.

EMPLOYER

•Keep a copy of this form for a minimum of three years from the date the driver is no longer in your employ.

•The Certificate of Driving Skill (DL 170ETP) is not required to waive a driving test for a Class B with passenger endorse- ment if the driver holds a valid School Bus Certificate, Student Pupil Activity Bus Certificate, or a General Public Paratransit Vehicle Certificate unless the driver is upgrading or removing restrictions.

•A drive test is required for each DL 170ETP issued.

•A separate DL 170ETP is required for each class of drive test if drive test dates or examiners are different.

•A separate and complete drive test is required to remove a restriction or add a Passenger Endorsement.

•Issue a DL 170ETP only to drivers who:

–are employed by you at the time the certificate is issued,

–have taken the required training, and

–have taken a drive test equivalent to DMV’s drive test requirements and standards.

DMV EMPLOYEE

•Route the DL 170ETP to the Employer Testing Program Unit at M/S L224. DO NOT send to Micrographics.

•Is all required information (i.e., type of drive test(s), restriction(s) required, all dates, signatures, EN number) complete?

DESCRIPTION OF VEHICLE CLASSES

CLASS A Also see “Required Endorsements” listed below

You may drive:

• Any legal combination of Class A, Class B or Class C vehicles if properly endorsed (some restrictions may apply).

You may tow:

•Any vehicle or trailer (Class A authorizes towing vehicles or trailers exceeding 10,000 lbs. GVWR).

•Double/triple trailers, with endorsement.

•A trailer bus, with endorsement.

CLASS B Also see “Required Endorsements” listed below

You may drive:

•Any single vehicle with 3 or more axles weighing more than 6,000 lbs. GVWR (some restrictions may apply).

•Any single vehicle weighing 26,001 lbs. or more GVWR (some restrictions may apply).

•Any bus (except a trailer bus) if properly endorsed (some restrictions may apply).

•You may not drive a school bus unless you passed a drive test in a school bus and have a school bus endorsement.

You may tow:

• Another vehicle or trailer under 10,000 lbs. GVWR.

CLASS C

This form cannot be used to qualify for a commercial Class C driver license.

REQUIRED ENDORSEMENTS NOTE: Driver is required to obtain

•Double Triple Endorsement — for double and triple trailers.

•Passenger Endorsement — for passenger transport vehicles, which include, but is not limited to a bus. (Restrictions may apply depending on size of bus.) NOTE: Mechanics who drive a bus while servicing it, must have a passenger endorsement.

•Tank Vehicle Endorsement — For any size permanently attached tank or any portable tank with capacity of over 1,000 gallons.

•Hazardous Materials or Hazardous Waste Endorsement — For any vehicle carrying hazardous materials or wastes which must be placarded or as defined in Health and Safety Code §25115 and §25117.

DL 170 ETP (REV. 9/2006) WWW