Ds 875Y Form PDF Details

Navigating the intricacies of driving regulations can sometimes be overwhelming, especially when it involves the need to understand specific forms such as the DS-875Y. Issued by the New York State Department of Motor Vehicles, this form plays a critical role in the certification process for drivers who are required to comply with Article 19-A. The Article 19-A Oral/Written Examination Results form, as its name suggests, is designed to capture the outcome of either an oral or written examination that a driver undergoes as part of their certification or recertification process. Exam results, noted by a certified examiner, determine whether a driver passes or fails. The form meticulously records not only the type of examination—oral or written—but also the driver's information including their name, date of birth, address, and licensing details like the client/license ID number, state class of their license, and any applicable endorsements or restrictions. Additionally, it collects crucial information about the carrier or the employing entity, underlining its relevance in ensuring that drivers meet the regulatory requirements set forth. The examiner's certification at the bottom of the form underscores the authenticity of the testing process and the accuracy of the results entered, making it an essential document for maintaining safety standards and compliance within the New York State driving community. By providing a structured and standardized method to report test outcomes, the DS-875Y form plays an indispensable role in the regulatory ecosystem, ensuring that only qualified individuals are at the helm, contributing to safer roadways for everyone.

QuestionAnswer
Form NameDs 875Y Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesds 875z, nys ds 875 answers, ds form 875z, nysdmv form619

Form Preview Example

DS-875Y (6/11)

NewYorkStateDepartmentofMotorVehicles

ARTICLE 19-AORAL/WRITTEN EXAMINATION RESULTS

INSTRUCTIONS TO CERTIFIED EXAMINER

After administering the exam, and using the answer key provided (Form DS-875Z, “Article 19-A Written Examination AnswerSheet”),completethisformandattachittothedriver’scompletedexamination.

 

 

TYPE OF EXAMINATION

 

 

 

 

 

 

 

 

 

Oral Written

Re-examination

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver’s Last Name

 

 

First

 

 

 

 

M.I.

 

 

Date of Birth (Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

 

City

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Client/License ID Number

 

 

State

 

Class of Driver’s License

Endorsements

Restrictions

 

 

Expiration Date

(from Driver License)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CARRIER INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier/DBA Name

 

Legal Name (if different)

 

 

 

Federal ID Number

19-A Business ID Number

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

City

 

State

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER EXAMINATION RESULTS

Passed

Failed - Driver Disqualified

EXAMINER’S CERTIFICATION

I certify that I have tested the above driver in compliance with Section 6.12 and/or Section 6.15 of Part 6 of the Commissioner’s Regulations. The employer has been notified of the results.

Certified Examiner’s Name

Client/License ID Number (from Driver License)

Certificate Number

Certification Class

 

 

Endorsements

Restrictions

Expiration Date

Certified Examiner’s Signature

-

Date of Examination

www.dmv.ny.gov

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Filling out part 1 in ds 875y

2. The subsequent step is usually to fill in all of the following blanks: DRIVER EXAMINATION RESULTS, Passed, Failed Driver Disqualified, EXAMINERS CERTIFICATION, I certify that I have tested the, Certified Examiners Name, ClientLicense ID Number from, Certificate Number, Certification Class, Endorsements, Restrictions, Expiration Date, Certified Examiners Signature, Date of Examination, and wwwdmvnygov.

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