Dmv Form R 390 PDF Details

When you are getting a driver's license in the state of California, there are a few things that you will need to bring with you. One of those items is the DMV Form R 390, also known as the "Medical Examination Report." This document is used to report your health information to the DMV and verify that you meet their standards for licensing. In this post, we will go over what is required on the form and who needs to fill it out. We will also provide some tips on how to complete it accurately. Keep reading for more information!

QuestionAnswer
Form NameDmv Form R 390
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesr 390 ct dmv room 305 form

Form Preview Example

ANNUAL REPORT OF APPOINTMENT OF

SCHOOL BUS SAFETY COORDINATOR

R-390 Rev. 7-2013

STATE OF CONNECTICUT

DEPARTMENT OF MOTOR VEHICLES

INSTRUCTIONS:

1.Complete entire report - one for each coordinator, please print or type

2.Send to DMV prior to commencement of the school year

3.Report changes to DMV by mail within 10 days

MAIL TO: DMV DRIVER ED UNIT, 60 STATE STREET, ROOM 305, WETHERSFIELD CT 06161

PART I

 

SCHOOL YEAR:

 

TERM OF APPOINTMENT:

TYPE OF REPORT:

 

 

 

 

 

 

 

 

 

FROM:

 

TO:

FROM:

TO:

ANNUAL

CHANGE (Describe change)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF CARRIER/LOCAL-REGIONAL BOARD OF EDUCATION

FULL NAME OF AUTHORIZED CONTACT PERSON

BUSINESS STREET ADDRESS

FULL TITLE OF AUTHORIZED CONTACT PERSON

CITY/TOWN/STATE/POSTAL CODE

BUSINESS PHONE

CELL PHONE

MAILING ADDRESS IF DIFFERENT FROM BUSINESS ADDRESS

E-MAIL ADDRESS

FAX NO.

CITY/TOWN/STATE/POSTAL CODE

FULL NAME OF SAFETY COORDINATOR

PART II

FULL NAME OF SAFETY COORDINATOR

DATE OF BIRTH

IF CERTIFIED INSTRUCTOR, ID NO.

STREET ADDRESS (HOME)

OPERATOR LIC. NO.

LAST PROF. TEST DATE (S ENDORS.)

MAILING ADDRESS IF DIFFERENT FROM STREET ADDRESS

LICENSE CLASS

ENDORSEMENTS

RESTRICTIONS

CITY/TOWN/STATE/POSTAL CODE

DAYTIME TELEPHONE NO.

E-MAIL ADDRESS

PART III

SIGNATURE OF AUTHORIZED CONTACT PERSON

DATE SIGNED

SIGNATURE OF SAFETY COORDINATOR

DATE SIGNED

SIGNATURE OF MASTER INSTRUCTOR

MI ID NO.

DATE SIGNED

PART IV - FOR DMV USE ONLY

DMV STAFF

DMV STAFF TITLE

APPROVAL GRANTED

YES NO

DATE

REASON FOR DENIAL OF APPLICATION

Sec. 14-275c-48 Appointment of a safety coordinator

(a)Each carrier which is not an individual person shall appoint one or more safety coordinator(s) who shall be responsible for carrying out the duties imposed on the carrier in accordance with the requirements of Sections 14-275c-46 through 14-275c-53 of these regulations. The safety coordinator(s) shall also serve as the carrier's contact person for the department with respect to driving qualifications. Each carrier required to appoint a safety coordinator(s) shall report to the commissioner annually in writing prior to the beginning of each school year the name, address and telephone number of its safety coordinator(s), and shall notify the commissioner in writing of any change in the information so reported.

(b)Any local or regional board of education or other authority responsible for primary, secondary or special education whose carriers are individual persons shall appoint a safety coordinator having the same duties as specified in subsection (a) of this section. Each authority required to appoint a safety coordinator shall report to the commissioner annually in writing prior to the beginning of each school year the name, address and telephone number of the safety coordinator so appointed, and shall notify the commissioner in writing of any change in the information so reported.

(Effective January 25, 1994)

How to Edit Dmv Form R 390 Online for Free

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Step 1: First of all, access the tool by clicking the "Get Form Button" above on this webpage.

Step 2: When you open the online editor, you will notice the form all set to be filled out. Other than filling in different blanks, you could also do some other actions with the PDF, particularly putting on any text, editing the initial text, adding images, putting your signature on the form, and much more.

This PDF will require specific data to be entered, so ensure you take the time to enter what's requested:

1. The Dmv Form R 390 needs specific information to be inserted. Ensure that the following blank fields are completed:

Filling out segment 1 in Dmv Form R 390

2. Once the previous segment is done, you'll want to insert the necessary specifics in STREET ADDRESS Home, OPERATOR LIC NO, LAST PROF TEST DATE S ENDORS, MAILING ADDRESS IF DIFFERENT FROM, LICENSE CLASS, ENDORSEMENTS, RESTRICTIONS, CITYTOWNSTATEPOSTAL CODE, DAYTIME TELEPHONE NO, EMAIL ADDRESS, PART III, SIGNATURE OF AUTHORIZED CONTACT, DATE SIGNED, SIGNATURE OF SAFETY COORDINATOR, and DATE SIGNED so you can move forward further.

LAST PROF TEST DATE S ENDORS, SIGNATURE OF SAFETY COORDINATOR, and MAILING ADDRESS IF DIFFERENT FROM inside Dmv Form R 390

When it comes to LAST PROF TEST DATE S ENDORS and SIGNATURE OF SAFETY COORDINATOR, ensure you get them right in this current part. The two of these could be the most significant ones in the PDF.

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