The DMV Form CDL28 is an application for a Commercial Driver's License (CDL). To complete the form, you will need to provide your personal information, as well as your driver's license history and employment history. The form also requires you to list any traffic violations or accidents you have been involved in within the last 10 years. If you meet all of the requirements, the DMV will issue you a CDL. Completing the form accurately is essential, so be sure to consult with a licensed DMV agent if you have any questions.
| Question | Answer |
|---|---|
| Form Name | Dmv Form Cdl28 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | cdl28 cdl 28 form |
Commercial Drivers License
555 Wright Way, Carson City
810 E. Greg St, Sparks, NV 89431
4110 Donovan Way, N Las Vegas, NV 89030
3505 Construction Way, Winnemucca, NV 89445
3950 E. Idaho St, Elko, NV 89801
178 N. Avenue F, Ely, NV 89301
THIRD PARTY CERTIFIER APPLICATION
NRS 483.912, NAC 483.125 to 483.197
Original Certification Recertification
Part I – To be completed by Certifier
Name: ___________________________________________________________________________
Employer: ________________________________________ Telephone: ____________________
Physical Address: _________________________________________________________________
StreetCityState Zip
Mailing Address: ___________________________________________________________________
Street/PO Box |
City |
State Zip |
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CONFIDENTIAL INFORMATION |
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Driver’s License Number: ______________________ State: ______ Exp. Date ________________
Vehicle Class: A |
B |
C |
M |
Endorsements: |
T |
P |
N |
H |
S |
X |
Social Security No: __________________________________ |
Date of Birth: __________________ |
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Yes |
No |
1.Have you ever had a driver’s license in another state?
If Yes, what states? ___________________________________________________
2.Has your driver’s license ever been suspended, revoked, cancelled or is it subject to disqualification? If Yes, please explain: ____________________________________
____________________________________________________________________
3.Have you been convicted of driving under the influence of alcohol or a controlled substance in the past 7 years?
4.Have you been convicted of a gross misdemeanor or felony relating to the management of money, fraud or embezzlement? If Yes, please explain: __________
____________________________________________________________________
5.Have you operated a commercial motor vehicle for at least two years?
6.What is your position with your present employer? _____________________________________
7.How long have you worked for this employer? ________________________________________
If less than two years, where did you work before and for how long? _______________________
_____________________________________________________________________________
I certify under penalty of perjury that the information on this application is true and accurate. I authorize the Department of Motor Vehicles to conduct any background investigation necessary to evaluate my driving, employment or credit history.
Signature: ____________________________________________ Date: ______________________
CDL28(8/2012) |
Signatures must be originals. Photocopies are not acceptable. |
Changes may not be made to this form once it is signed.
Part II – To be completed by Employer
I certify I am an authorized representative of __________________________________________________
Name of Company
and request the Department of Motor Vehicles review the application of __________________________
Name of Certifier
and if qualified, to enroll him/her in the authorized class for third party certification of driving ability.
Name: _______________________________________________ Title: ______________________
Signature: ____________________________________________ Date: ______________________
DEPARTMENT USE ONLY
Application reviewed by: _________________________________ |
Date: ______________________ |
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Nevada Record Check: |
Yes |
No |
Date: ______________________ |
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CDLIS check: |
Yes |
No |
PDPS check: Yes No |
Date: ______________________ |
Other (please explain) : _____________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Approved: Denied: Enrolled in Class Number: __________________________
Certifier Number _______________________ Company Number ____________________________
Enrolled in Class Number: _______________ Class Dates _________________________________
CDL Supervisor Signature: _______________________________________ Date: _____________
CDL28(8/2012) |
Signatures must be originals. Photocopies are not acceptable. |
|
Changes may not be made to this form once it is signed. |