Field Services Division
Reno/Carson City 684-4DMV
Las Vegas 486-4DMV
Rural NV (877) 368-7828
www.dmvnv.com
RESTRICTED LICENSE INFORMATION
A restricted license may be obtained for a variety of reasons.
Juveniles in certain rural areas who need to drive in order to attend school or to transport themselves or a family member to medical appointments may apply for a restricted license.
Individuals who have had their license suspended or revoked and have served at least half of their withdrawal period may apply for a restricted license to drive on the job or to/from work, school, grocery store, medical appointments or for court-ordered child visitation.
Exceptions apply for ignition interlock requirements, child support suspensions and some juvenile suspensions. Please call the appropriate phone number above for the address of a DMV Restricted License office near you.
APPLICATION: A restricted license cannot be approved for commercial driving purposes, to seek employment, or for public school students in Carson City, Clark, Douglas or Washoe Counties.
Complete all sections of the Application for Restricted License that pertain to you. Attach all required documents.
•Drive to/from work or drive on the job: Your employer must complete certain information on the application. Self- employed applicants must attach a copy of their business license or other acceptable document(s) to substantiate self-employment. Workdays and hours are limited to a maximum of six (6) days per week, ten (10) hours per day.
•Drive for medical purposes: A physician’s statement is required.
•Drive to/from medical appointments or a grocery store: The “Verification of Need” affidavit must be completed by an unbiased individual and signed in front of a DMV authorized representative.
•Minor drive to/from school or work: School authorities and parents/guardians must complete certain sections.
SR-22: Proof of financial responsibility (SR-22 Certificate of Insurance) must be filed after any revocation and certain suspensions before a restricted license will be issued. The SR-22 insurance must be in place for a continuous three (3) year period from the date your driving privilege is reinstated.
TESTING & FEES: Applicants may be required to successfully complete written, vision, and drive examinations before a restricted license is issued. A reinstatement fee may be required.
IGNITION INTERLOCK DEVICE: If you have been ordered to install an ignition interlock device on your vehicle, proof of that installation must be submitted with your application for a restricted license. Nevada law requires that an applicant wait 45 days after a 1st DUI and one (1) year after a 3rd DUI before applying for a restricted license. A restricted license is prohibited by law after a 2nd DUI.
POINT VIOLATOR SUSPENSION: Per NAC 483.225, proof of completion or enrollment in an approved traffic safety course within the past 6 months is required for individuals whose license was suspended due to an accumulation of demerit points as outined in NRS 483.475.
DENIAL OF AN APPLICATION: A restricted license application will be denied if your license was suspended or revoked for any of the following:
1.A financial responsibility, medical or failure to appear suspension
2.Certain driving record convictions within the past five (5) years
3.The third demerit point suspension within the past five (5) years
DMV-136 (Rev. 02/2010)
Field Services Division
Reno/Carson City 684-4DMV
Las Vegas 486-4DMV
Rural NV (877) 368-7828
www.dmvnv.com
APPLICATION FOR RESTRICTED LICENSE
INSTRUCTIONS: Please type or print in BLACK ink. Failure to complete all applicable sections will cause considerable delay in processing your application. You will be notified by mail of your approval or denial and provided instructions on how to pick up your license. Bring, mail or fax this completed application to the DMV Restricted License office in your area:
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Northern Nevada |
305 Galletti Way, Reno NV 89512 |
Fax: (775) 684-3587 |
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Southern Nevada |
1399 American Pacific Drive, Henderson NV 89074 |
Fax: (702) 486-1300 |
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REQUEST TO DRIVE: |
To/from work |
To/from school |
For medical purposes |
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On the job for work-related purposes |
To/from grocery store |
APPLICANT INFORMATION
Name _____________________________________________________________________________ Home Phone __________________________
LastFirstMiddle
Residence Address ___________________________________________________________________ City/Zip _______________________________
Mailing Address (if different) ____________________________________________________________ City/Zip _______________________________
County_______________ Driver’s License # ______________________ Social Security #_____________________Date of Birth _______________
Does a licensed driver (not applicant) reside in the household?
No If “Yes,” name: ________________________________________
Relationship to Applicant_________________________________________ Driver’s license number____________________________________
(Effective 7/1/2010) If you are a male at least 18 and less than 26 years of age, would you like to register with the Selective Service? By registering, you will remain eligible for federal student loans, grants, benefits relating to job training, most federal jobs and, if applicable, citizenship in the United States. If YES, please initial here: _______________
SECTION A: DRIVE TO/FROM WORK; DRIVE ON THE JOB FOR WORK-RELATED PURPOSES
This license is effective only for employment designated on this application.
Most direct route from home to work__________________________________________________________________________________________
Exact # miles from your home to work, via most direct route _________________________
Are you self-employed? |
Yes |
No |
If “Yes,” provide a copy of your business license or other substantial proof. |
EMPLOYERS AND SELF-EMPLOYED APPLICANTS COMPLETE THE FOLLOWING:
Business name___________________________________________________________ Phone__________________________________________
Business address/city/zip __________________________________________________________________________________________________
Days Applicant works______________________________________________________ Exact hours: ____________am/pm to_____________am/pm
Applicant required to drive during work hours? |
Yes |
No |
If so, specify areas where applicant must drive (city, work yard, etc.) |
_______________________________________________________________________________________________________________________
VERIFICATION OF EMPLOYMENT (TO BE COMPLETED BY EMPLOYER)
I AM AUTHORIZED TO PROVIDE THE INFORMATION INDICATED ABOVE AND VERIFY THAT THE APPLICANT IS CURRENTLY EMPLOYED WITH THIS BUSINESS. I FURTHER CERTIFY THAT I WILL NOTIFY THE NEVADA DMV IF THIS EMPLOYEE TERMINATES EMPLOYMENT.
Signature of Applicant’s Superior_____________________________________________________________________ Date___________________
Print Name/Title__________________________________________________________________________________________________________
SECTION B: DRIVE TO/FROM GROCERY STORE
Name of grocery store____________________________________ Address_________________________________________________________
Most direct route from home to store_________________________________________________________________________________________
Exact # miles from your home to store, via most direct route _________________________
Specify 2 days per week for travel: (1)_________________ (2)_________________________ Two hours: _________ am/pm to ___________am/pm
“Verification of Need” must be completed - see Section F, “AFFIDAVITS, VERIFICATIONS”
SECTION C: DRIVE TO/FROM MEDICAL APPOINTMENTS - MEDICAL HARDSHIP IN FAMILY
Name of household member with medical condition________________________________________ Person’s Social Security #_________________
Nature of medical condition_________________________________________________________________________________________________
Name of medical provider________________________________________________Phone #____________________________________________
Address of medical provider_________________________________________________________________________________________________
Most direct route from home to medical provider___________________________________________________________________________________
Exact # miles from your home to medical provider, via most direct route _________________________
Dates of medical appointments______________________________________ Time_________________ am/pm (Attach additional sheets if necessary)
Attach statement from medical provider, on provider’s letterhead and dated within the past thirty (30) days. Must include (1) description of medical condition, (2) prescribed medications, (3) verification that medical condition renders person unable to operate a motor vehicle, (4) whether medical condition is temporary or permanent, (5) if temporary, estimated time for recovery, (6) any recommended restrictions. (NAC 483.266)
“Verification of Need” must be completed - see Section F, “AFFIDAVITS, VERIFICATIONS”
SECTION D: DRIVE TO/FROM SCHOOL
Per NRS 483.270, public school students from Carson City, Clark, Douglas and Washoe Counties are not eligible for a to/from school restricted license.
STUDENTS AGE 14-18: This license shall be issued for the current school year only and used exclusively for academic purposes, NOT extracurricular activities. The route shall be travelled on scheduled school days only, no more than once daily. Do not exceed posted speed limits.
If minor’s license was revoked or suspended under NRS 62, “Juvenile Justice,” attach certified copy of court order authorizing restricted driving privileges to and from school and/or work.
If minor is employed and needs to drive to/from work, also complete Section A of this form.
If home is less than 2 miles from school and student cannot walk, must submit physician statement meeting criteria of NAC 483.267.
Why is it impossible or impractical to provide transportation for this student? _________________________________________________________
______________________________________________________________________________________________________________________
Most direct route from home to school________________________________________________________________________________________
Exact # miles from your home to school, via most direct route _________________________
Specify days of week for travel _____________________________________________________ Hours: _________ am/pm to ___________am/pm
SCHOOL VERIFICATION (TO BE COMPLETED BY SCHOOL AUTHORITY)
Name of School_________________________________________________________________ Phone___________________________________
Address ________________________________________________________________________________________________________________
1. |
Is the student’s enrollment in this school based on an approved variance? |
Yes |
No |
|
|
2. |
Does the school provide bus transportation or transportation for hire to the student’s residential area? |
Yes |
No |
3. |
Dates of school semesters: (1st) Begins____________ Ends_____________ |
(2nd) Begins____________ |
Ends______________ |
4. |
Exact hours student attends school (exclude extracurricular activities) |
From __________________ am/pm to ___________________am/pm |
THE UNDERSIGNED ATTESTS THAT THE INFORMATION PROVIDED IS ACCURATE ACCORDING TO SCHOOL RECORDS.
Signature ______________________________________________________________________________________ Date____________________
Print Name/Title__________________________________________________________________________________________________________
SECTION E: DRIVE TO/FROM COURT-ORDERED CHILD VISITATION
Address where child(ren) reside, including city__________________________________________________________________________________
Most direct route from home to school________________________________________________________________________________________
Exact # miles from your home to child’s residence, via most direct route _________________________
Specify days of week for travel _____________________________________________________ Hours: _________ am/pm to ___________am/pm
Attach certified copy of court order authorizing restricted driving privileges to and from child visitation (NAC 483.252).
SECTION F: AFFIDAVITS, VERIFICATIONS
A Notary Public may verify any of the below signatures in place of a DMV representative (Notary statement and seal must be attached).
VERIFICATION OF NEED. This verification must be completed by an unbiased person (neighbor, social worker, clergyman) not residing in the household and be signed before a person authorized to administer oaths (NRS 483.300).
Print name_________________________________________________________________________ Phone_______________________________
Address/city/zip__________________________________________________________________________________________________________
Relationship to applicant_________________________________
Explain applicant’s inability to obtain other method of transportation___________________________________________________________________
Describe applicant’s or family member’s medical problems (if applicable) ________________________________________________________________
Signature___________________________________________________________________________ Date________________________________
Authorized DMV Representative_____________________________________ Print Name_______________________________________________
APPLICANT AFFIDAVIT (TO BE SIGNED BY ALL APPLICANTS)
I UNDERSTAND THAT MY RESTRICTED LICENSE WILL BE CANCELLED BY THE DEPARTMENT IF:
1.I am convicted of a traffic violation which is assigned 4 or more demerit points.
2.My driving privilege is suspended, revoked or cancelled for any reason other than the reason I am applying for this license.
3.I fail to maintain proof of financial responsibility as required by NRS 485.307.
4.I fail to notify the DMV in writing whenever I change my address, employment or any other information included in this application within 10 days after the change occurs. I understand this change must be submitted to the same office where I am applying for this license. (NRS 483.240)
5.I fail to submit proof of completion or enrollment in an approved traffic safety school if required by NAC 483.225.
I CERTIFY UNDER PENALTY OF PERJURY THAT ALL STATEMENTS MADE ON THIS APPLICATION ARE TRUE AND CORRECT. I UNDERSTAND THAT ANY MISSTATEMENT MAY CAUSE DENIAL AND/OR CANCELLATION OF MY RESTRICTED LICENSE, AND THAT FAILURE TO COMPLY WITH RESTRICTIONS OR ANY CONDITIONS OF THE RESTRICTED LICENSE MAY RESULT IN CANCELLATION OF THIS PRIVILEGE.
Applicant Signature____________________________________________________________________ Date______________________________
Authorized DMV Representative_____________________________________ Print Name_______________________________________________
PARENT/GUARDIAN AFFIDAVIT (TO BE COMPLETED AND SIGNED BY PARENT OR GUARDIAN OF MINOR APPLICANT) Father’s/Guardian’s name______________________________________________________ Driver’s License #___________________________
Address______________________________________________________________________ Home Phone______________________________
Employer’s name/address_________________________________________________________________________________________________
Work days/hours_______________________________________________________________ Work Phone_______________________________
Mother’s/Guardian’s name______________________________________________________ Driver’s License #__________________________
Address______________________________________________________________________ Home Phone______________________________
Employer’s name/address_________________________________________________________________________________________________
Work days/hours_______________________________________________________________ Work Phone_______________________________
I CERTIFY THAT I AM THE PARENT OR GUARDIAN OF THE APPLICANT AND THAT ALL STATEMENTS MADE ON THIS APPLICATION ARE CORRECT. I UNDERSTAND THAT ANY MISSTATEMENT MAY CAUSE DENIAL AND/OR CANCELLATION OF THE LICENSE. I ACCEPT LIABILITY FOR ANY NEGLECT OR WILLFUL MISCONDUCT BY THE MINOR AND AGREE THAT FAILURE OF THE MINOR TO COMPLY WITH RESTRICTIONS OR ANY CONDITIONS OF THE RESTRICTED LICENSE MAY RESULT IN CANCELLATION OF THIS PRIVILEGE.
Parent/Guardian Signature_______________________________________________________________ Date______________________________
Authorized DMV Representative_____________________________________ Print Name_______________________________________________
FOR DEPARTMENT USE: |
Verified ___________________________________________________ |
Date ____________________ |
SR-22: |
Needed |
Filed |
No |
Traffic Safety School: |
Yes |
No |
PDPS: |
No Match |
LIC |
ELG |
NOT State ________ Number ___________________________________ |
Approved |
Denied |
Reason Denied ___________________________________________________________________________ |
Eligibility Date ________________ Expiration Date _________________ Restricted License No. __________________________________________
