DMV DL 120 Form – Fill Out and Use This PDF

Enter Full Name, Date of Birth, Home Telephone Number, Day Telephone Number (if different), Street Address, City, State and Zip Code.

If prior Junior Permit application made for applicant or other family member, give name and year. Enter the Current CA ID Number.

Check all that apply: Family Illness, School, To and From Work, Family Enterprise.

Describe applicant's essential driving needs.

Enter the distance from applicant's residence to nearest public transportation location, and the location by streets of nearest bus or train stop.

Describe best bus or train route, give name of service, telephone number, name or number of individual line(s), departure, transfer and arrival times, etc.

List names and driver license numbers of all drivers in the household.

Explain specifically why each driver in the household cannot do the required driving. Include daily work or school and travel schedule of each driver, nature and location of employment and distance from home and applicant's school. Include number of employees, if self-employed.

If household includes non-driving adult or minor older than applicant, give name and relationship to applicant and explain why person can not/does not drive. (If medical reason, separate statement of facts by physician needed.)

Explain why carpools, taxis, bicycles, walking, vanpools, etc. cannot be used.

Has applicant completed approved driver education and training courses? (If no, reason.)

Mark Yes or No. If a Junior Permit is issued, certificates of completion of driver education and training must be on file within six months or the permit must be cancelled. Describe plan to complete courses if permit is issued.

Section 5 is required if request is due to family illness: establish the relationship between the ill person and the applicant. Indicate whether or not the person's illness prevents them driving and for how long.

Section 5A, Statement of Facts by Physician, is required if due to family illness.

Section 6 is required if request is based on need for transportation to and from school: describe transportation arrangements to date. Explain the change in circumstances that now makes the applicant's operation of a motor vehicle essential.

Section 6A, Statement of Facts by School Principal, is required for transportation to and from school.

Section 7 is required if request is based on need for transportation to and from work: explain changes in family circumstances that now make applicant's income essential in the support of the family. Describe use of applicant's income. List all other sources of family's income.

Section 7A, Statement of Facts by Employer, is required for transportation to and from work.

Section 8 is required if request is based on family enterprise: enter name and address of enterprise, nature and type of enterprise, years in business and number of employees (include family members).

Explain specifically why each employee cannot do the requested driving. Include daily work and travel schedule of each employee. Show how the family income depends on the operation of the enterprise. Explain why someone cannot be hired to do the requested driving. Explain why enterprise would be unable to continue unless applicant operates a motor vehicle.

Enter hours per week applicant would work and salary (if any).

Enter name of signer (print or type), title, address, city, state, zip, signature, date and telephone number.

Parent/guardian authorizes the Department of Motor Vehicles to ask for and receive any additional information needed to determine eligibility for a Junior Permit from physician, school principal, and/or employer certifying to a Statement of Facts. Medical information is confidential under CVC §1808.5.

Parent/guardian certifies (or declares) under penalty of perjury under the laws of the State of California that it is true and correct.

Each parent/guardian enters signature, date, address, city, state and zip.

Completed application must be submitted in person to the local office of the Department of Motor Vehicles. Attach separate sheet if more space is needed. Incomplete information may delay decision. Applicant must have already applied for CA Identification card prior to submitting this application. Driver License or Identification Card Application (DL 44) must be submitted with this form.