Dmv Public Service License Form PDF Details

When applying for your DMV public service license form, make sure you are fully prepared with the required documents and information. The application process can seem daunting, but our guide will walk you through everything you need to know. In addition to the standard documentation, be prepared to answer some questions about your driving history and abilities. With the right preparation, you can submit your application with ease and get on your way to providing essential services for your community.

QuestionAnswer
Form NameDmv Public Service License Form
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesct r, psl license ct, ct 7 motor vehicles, ct public service license

Form Preview Example

APPLICATION FOR PUBLIC

STATE OF CONNECTICUT

PASSENGER ENDORSEMENT

DEPARTMENT OF MOTOR VEHICLES

R-7 REV. 8-2021

PASSENGER ENDORSEMENT REVIEW UNIT

INSTRUCTIONS

On The Web At ct.gov/dmv

 

1.Complete DCF-3031 form and submit to Department of Children and Families PRIOR to submitting the application (S, V and A endorsements only) and mail to: DCF Careline Background Searches, 505 Hudson St. 5th floor, Hartford, CT 06106 or Fax to: (860)560-707

2.Complete Part 1, 2, 3 (F endorsement applications not required to complete this section) and 4.

a.Type/Print clearly with pen.

b.Part 3 (if required) and 4 must be signed by the applicant.

3.Section 4 Instructions: Attach all documents listed in A or B depending on your residency status. All documents must be submitted, if all documents listed are not submitted your application CANNOT be accepted.

PART 1

1.APPLICANT'S NAME (Last, First, Middle Initial)

2. GENDER

M F X

3. DATE OF BIRTH

4. SOCIAL SECURITY NUMBER

5. LIST ANY OTHER NAMES EVER USED (Alias, Maiden, etc.)

6.BIRTHPLACE (If foreign born, include country)

7.MAILING ADDRESS (Number and Street, City or Town, State, Zip Code)

8. RESIDENCE ADDRESS (If different from mailing address)

 

9. NAME AND PLACE OF EMPLOYMENT (Business name and complete address)

 

 

 

 

 

 

 

10. LICENSE CLASS

 

 

 

11. OPERATOR'S LICENSE NUMBER

 

12. DAYTIME NUMBER

A

B

C

D

 

 

 

(

)

 

 

 

 

 

 

 

 

 

13. SELECT TYPE OF ENDORSEMENT YOU ARE APPLYING FOR:

SCHOOL BUS (S)

STUDENT TRANSPORTATION (V)

ACTIVITY VEHICLE (A)

TAXI LIVERY SERVICE BUS (F)

IMPORTANT: Notification of approval/denial of endorsement can be sent either by mail or e-mail. Utilizing e-mail will help to shorten the processing time. If you would like your notification e-mailed please provide it.

14.E-MAIL: (IF YOU WISH TO BE CONTACTED VIA E-MAIL PLEASE LIST)

 

 

 

 

PART 2

 

 

QUESTION

YES

NO

EXPLANATION

 

( )

( )

 

 

 

 

 

 

 

 

IF "YES", WHAT STATE(S) OR COUNTRY?

 

 

15. Have you lived in another state or country

 

 

 

 

during the past five years?

 

 

 

 

 

 

(ATTACH CERTIFIED DRIVING AND CRIMINAL HISTORY FOR EACH STATE OR COUNTRY)

 

 

16. Have you ever held a driver's license

IF "YES", WHAT STATE(S) OR COUNTRY?

 

 

 

 

 

 

issued by any other state or country during the

 

 

 

 

past five years?

(ATTACH CERTIFIED DRIVING AND CRIMINAL HISTORY FOR EACH STATE OR COUNTRY)

 

 

 

 

 

 

17. Do you meet all the physical requirements

IF NO, PLEASE EXPLAIN

 

 

 

 

 

 

as set forth in Section 14-44 CGS and Title 49

 

 

 

 

CFR Section 391.41?

 

 

 

 

 

 

 

 

 

 

18. Have you ever been treated for any health

 

 

 

 

condition which is likely to cause a loss of

 

 

 

 

consciousness or any other loss of ability to

 

 

 

 

control a motor vehicle?

 

 

 

 

19. Have you ever been convicted of an

 

 

 

 

alcohol or drug related offense relative to the

 

IF YOU INDICATE YES TO QUESTIONS 18-20 YOU MUST

 

 

operation of a motor vehicle?

 

 

 

 

 

 

 

 

 

 

ATTACH A STATEMENT EXPLAINING THE CIRCUMSTANCES

 

 

20. Are there any criminal charges currently

 

 

 

pending against you?

 

 

 

 

 

 

 

 

 

21. Have you EVER BEEN CONVICTED of a

 

 

 

crime, offense, forfeited bond or collateral?

 

 

 

(Exclude minor traffic violations, or any offense

 

 

 

settled in a juvenile court or under a youthful

 

 

 

offender law).

 

 

 

 

 

 

 

PART 3 Signature Required

I

 

do here by authorize

 

 

 

Print applicant name

 

 

the Dept. of Children and Families to research its records to determine if I am listed on the Central Registry of Perpetrators of Child Abuse and Neglect. I understand that this information will be used solely to determine my suitability for whether I am a proper person to be issued a Connecticut Public Passenger endorsement by the Dept. of Motor Vehicles. I release the Dept. of Children and Families from any liability for any damages I may incur which may result from the release/use of this information.

Date:

 

Applicant Signature:

This authorization will expire 180 days after the date of the signature.

Note: This search will not disclose substantiations or DCF involvement unless the person signing the release is listed on the Central Registry.

PART 4 Signature Required

Check applicable box A or B and attach below documents

A. CT Residents (more than 5 years)

- Medical Examiner Certificate (Form MCSA-5876) with a exam date within 90 days

- Copy of your valid CT license

- National Sex Offender Check, for more information go to: http://www.nsopw.gov

-

B. CT Residents (less than 5 years)

-

All of the above documents, plus

 

 

-

Certified criminal and driving history for any out-of-state/country

 

 

CERTIFICATION BY

 

I swear or affirm under penalty of false statement in accordance

 

SIGNATURE OF APPLICANT

 

 

 

with Connecticut General Statute 53a-157b that all information

 

X

APPLICANT

 

 

 

provided as part of this application is true and accurate.

 

 

DATE SIGNED

CONNECTICUT DMV REQUIREMENTS FOR

PUBLIC PASSENGER ENDORSEMENTS

STATE OF CONNECTICUT

DEPARTMENT OF MOTOR VEHICLES

 

 

On The Web At ct.gov/dmv

 

 

 

 

Below is a checklist of all documentation that must be submitted to apply for a public passenger endorsement:

1.S, V and A endorsement applicants only: Authorization for Release of Information for DCF CPS Search (DCF-3031): This

form must be mailed directly to Department of Children and Families. Mail this form to: DCF Careline Background Searches,

505 Hudson St - 5th floor, Harford, CT 06106 or Fax to (860)560-7071. Important: Failure to complete and mail this form to DCF prior to submitting your application to DMV will result in a delay of the processing of your application.

All the forms listed below must be mailed to the Department of Motor Vehicles

2.Application for Public Passenger Endorsement (R-7). Make sure it's signed and dated.

3.Medical Examiner Certificate Form - MCSA-5876, the exam date on the certificate must be within 90 days of applying for the endorsement.

4.Sex offender check: This can be obtained by visiting the following website: http://www.nsopw.gov (if there are AKA's (other names used), all names must be run). The check submitted must have a date stamp from the printer it is printed from. The date stamp must be within five (5) days of the date of application.

5. Copy of your valid Connecticut license

Applicants who have held a license in CT less than five years MUST also submit:

6. A CERTIFIED DRIVING history and CRIMINAL history from any previous licensing state(s)/countries. The histories must cover the last five years. Applicants from the following CLOSED criminal record states: AZ, CA, MS, NC, TN and VT are only required to submit the certified driving history.

The above forms should be mailed/dropped off to:

Department of Motor Vehicles

60 State Street

Wethersfield, CT 06109

Attention: Public Passenger Endorsement Review Unit

Applications may be hand-delivered to the Wethersfield office ONLY. There is a drop off box located inside the main entrance.

To pre-enroll for fingerprinting for the criminal background check please use the link below:

https://ct.flexcheck.us.idemia.io/cchrspreenroll

The service code for all passenger endorsements is 618E-A155 and the fee of $88.25 is payable online by credit card.

All prints will be submitted electronically or must be sent with the authorization code directly to:

DESPP

1111 Country Club Rd.

Middletown, CT 06437

Processing Time for application: approximately 6-8 weeks. A letter/e-mail will be sent to the applicant via e-mail/letter (depending on applicant's request).

Approved Applicants: within 90 days of receiving an approval the applicant will be required to either appear at a Hub branch contact the Passenger Endorsement Review Unit with applicable paperwork and fees.

Class A, B and C drivers will be required to appear at a Hub office.

S endorsement only: Proof they have passed proficiency test.

V endorsement only: Training certificate (R-360)

Fee: $12.00 for each remaining year on license.

Connecticut Department of Children and Families

AUTHORIZATION FOR RELEASE OF INFORMATION FOR DCF CPS SEARCH

DCF-3031 8/19 (Rev.)

I, (Applicant Name):

do hereby authorize the Department of Children and Families to research its records and if applicable request out of state checks, to determine whether or not I am on the central registry of persons responsible for child abuse and neglect I understand that this information may be used to determine my suitability solely for (check one):

Employment

Day Care

Volunteer

Intern

Mentor

Other:

 

 

 

 

Page 1 of 1

(This area for DCF Use only) Date Processed:

Central Registry:

YES

NO

Processor’s Initials:

Name of Agency (requesting background check):

 

 

 

 

Attention:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address: (No. and Street):

 

 

 

 

 

 

City:

 

 

 

 

 

State:

 

 

 

Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I release the Department of Children and Families from any liability for any damages I may incur which may result from the release / use of this information.

I submit my following information to assist the Department of Children and Families in their search.

 

 

 

 

 

 

Applicant Last Name

Applicant First Name:

 

Middle:

 

 

 

 

DOB:

 

 

 

SS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applicant Address: (No. and Street):

 

 

Apartment #:

 

City:

 

 

 

 

State:

 

 

Zip:

Years at current address?”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Years

 

 

 

 

Months

List All Previous Applicant Address(es) for the Last Five Years

 

 

 

 

 

 

 

 

Check if an additional sheet is necessary, and attached

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address: (No. and Street):

 

Apartment #:

 

 

City:

 

 

State:

 

 

Zip:

Dates From:

 

 

Dates To:

 

 

 

 

 

 

 

Month

Year

 

Month

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Names I have Used – Including Maiden, Previous Marriages(s)

 

 

 

 

 

 

 

Check if an additional sheet is necessary and attached

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Name

 

First Name:

 

 

Middle:

 

 

 

DOB:

 

 

 

SS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Spouses/Other Adults in the Home – Past and Present

 

 

 

 

 

 

 

 

Check if an additional sheet is necessary and attached

Last Name

 

 

First Name:

 

 

 

 

 

 

Middle:

 

 

 

DOB:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Names of ALL Child(ren) –Biological, Stepchildren, Including Adult Children In or Out of the Home

Check if an additional sheet is necessary and attached

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Name

 

First Name:

 

 

Middle:

 

 

 

DOB:

 

 

Gender:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

 

Male

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

 

Male

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

 

Male

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

 

Male

Unknown

 

 

 

 

 

 

 

 

 

 

 

Do you have an active DCF investigation at this time?

Yes

No

 

Do you have an active appeal of a DCF investigation at this time?

Yes

No

Applicant Signature:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This authorization will expire 180 days after the date of the signature. Forms not filled out completely and / or clearly will be returned. Do not leave any blank spaces. Please specify with “N/A” if not applicable. **DCF Conducts a Search of the CT Registry ONLY** The Accuracy of this Search is Limited to the Information Provided by the Applicant to DCF

How To Submit: Email: DCF.BackgroundCheck@ct.gov | Fax: 860-560-7071 | Mail: DCF-Background Check Unit, 505 Hudson Street, Hartford, CT 06106

Please be advised that due to the large volume of forms received, we are unable to provide confirmation of receipt or status updates during the background check

process. If, after 4 weeks, you do not receive the results of any form(s) you sent in or if you have any questions, please contact the BGC Unit.

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