Michigan Department of State
COMMERCIAL DRIVER LICENSE CERTIFICATION
Full Name: (Please Print)
Driver’s License Number:
I am applying for the following Commercial Driver License (CDL):
CDL GROUP DESIGNATION: (Choose only one) See reverse side for description of CDL group designations.
GROUP A |
GROUP B |
GROUP C |
CDL ENDORSEMENTS: (Choose as many as you need) See reverse side for description of CDL endorsements.
CERTIFYING TO THE TYPE OF COMMERCIAL MOTOR VEHICLE (CMV) DRIVING I WILL DO AS REQUIRED IN 49 CFR PARTS 383 AND 391 (Choose only one): See the reverse side for more information on driving types.
I will operate, or expect to operate a vehicle used in the following manner:
Non-excepted interstate - I will operate a commercial motor vehicle outside of Michigan and am legally required to have a medical certificate. You must also provide a medical certification document.
Excepted interstate - I will operate a commercial motor vehicle outside of Michigan, only for an excepted purpose and am not legally required to have a medical certificate.
Non-excepted intrastate - I will operate a commercial motor vehicle only within Michigan (intrastate commerce) and am legally required to have a medical certificate.
Excepted intrastate - I will operate a commercial motor vehicle only within Michigan for an excepted purpose and am not legally required to have a medical certificate.
CDL RESTRICTIONS: (Choose only one)
The vehicle I will operate is: |
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Equipped with air brakes |
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Not equipped with air brakes (Restriction Code 28) |
Please answer all of the following questions. Your driving record will be verified before you take any test. A starred (*) response to one or more of these questions will disqualify you from obtaining a CDL.
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Do you reside at a permanent Michigan address with the intention of remaining in Michigan? |
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Yes |
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No |
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Do you have a driver’s license from more than one state? (Section 257.301 of the Michigan Vehicle Code and 49 CFR 383.21 of |
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No |
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Yes |
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the Federal Safety Rules prohibit drivers from having more than one driver’s license.) |
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Are you currently disqualified or suspended from operating commercial motor vehicles in Michigan or any state? |
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Yes |
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No |
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Is your driving privilege currently suspended, revoked, denied, or canceled in Michigan or any state? |
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Yes |
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No |
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5. Unless exempt under the Federal Motor Carrier Safety Administration (FMCSA) rules, do you meet the driver qualification |
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Yes |
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No |
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standards to operate a commercial motor vehicle as stated in 49 CFR Part 391? If yes, you should have a valid Medical |
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Examiner’s Certificate (also known as a DOT card) and a valid FMCSA Skills Performance Evaluation as needed. |
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6. Unless exempt under the FMCSA rules, do you meet the qualification standards to operate a commercial motor vehicle under the |
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Yes |
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No |
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Michigan Motor Carrier Safety Act (1963 PA 181) or Michigan Pupil Transportation Act (1990 PA 187)? If yes, you should have |
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either a valid Michigan Motor Carrier Waiver or a valid Medical Examiner’s Certificate (also know as a DOT card) if under the MI |
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Pupil Transportation Act. |
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If required, is the vehicle you will use for the CDL skills test representative of the vehicle that you will operate, once licensed? |
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Yes |
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No |
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8.As required by the Federal Motor Carrier Safety Regulations, Part 383, section 73, please list any state where you held a license within the last ten years.
_______________________ ______________________ |
______________________ ______________________ |
______________________ |
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9. As required by the Federal Motor Carrier Safety Regulations, Part 383.71, can you present proof of U.S. citizenship or Lawful |
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Yes |
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No |
Permanent Resident Status to obtain a Hazmat Endorsement? If no, Hazmat Endorsement cannot be issued. |
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Department of State Use only (Circle Document Type Presented) |
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Acceptable Proof of U.S. Citizenship: |
Acceptable Proof of Lawful Permanent Resident: |
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Unexpired U.S. passport or passport card
Original or certified copy of birth certificate issued by a state, county, Valid, unexpired Permanent Resident Card, issued by USCIS or INS. municipal authority, or outlying possession of the U.S. bearing an
official seal.
Consular Report of Birth Abroad issued by the U.S. Department of State (FS-240, DS-1350 or FS-545)
Certificate of Naturalization (N-550, N-570 or N-578) Certificate of U.S. Citizenship (N-560 or N-561)
I certify the information disclosed on this form is true. I understand making a false statement when applying for a driver’s license is a felony.
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Signature: X |
Date: |
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BFS-103 (07/12) |
Authority granted under Public Act 300, as amended. |
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Page 1 of 2
CDL GROUP DESIGNATIONS
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GROUP A |
GROUP B |
GROUP C |
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A vehicle towing a vehicle or trailer with a |
A vehicle with a GVWR of 26,001 pounds |
Any single vehicle, or combination of |
gross vehicle weight rating (GVWR) of |
or more. |
vehicles, that meets neither the definition of |
10,001 pounds or more when the gross |
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Group A nor that of Group B, but is either |
combination weight rating (GCWR) is 26,001 |
The Group B allows for towing trailers or |
designed to transport 16 or more |
pounds or more |
other vehicles with a GVWR of 10,000 |
passengers including the driver, or is used |
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pounds or less. |
in the transportation of materials found to |
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be hazardous and require the motor vehicle |
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to be placarded under the Hazardous |
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Materials Regulations (49 CFR part 172, |
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subpart F). |
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CDL ENDORSEMENTS |
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H – Hazardous Materials |
Needed to carry hazardous materials in amounts requiring a placard or any quantity of material listed as a |
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select agent or toxin in 42 CFR part 73. |
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N – Tank Vehicles |
Needed to haul liquids or liquefied gases in permanently mounted cargo tanks rated at 119 gallons or more |
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or portable cargo tanks rate at 1,000 gallons or more. |
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P – Passenger Vehicles |
Needed to operate any vehicle designed to transport 16 passengers or more, including the driver. |
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S – School Bus |
Needed to operate any commercial motor vehicle used to transport pre-primary, primary, or secondary school |
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students from home to school, school to home, or to and from school sponsored events. |
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T – Double/Triple Trailers |
Needed when towing two or more trailers with a single power unit. |
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DRIVING TYPES
Non-excepted interstate. Operates a commercial motor vehicle outside of Michigan and must provide a legible copy to the Secretary of State of one of the following medical certification documents:
A completed Medical Examiner’s Certificate signed by a medical professional. You must also keep this document with you until January 30, 2014 when operating a commercial motor vehicle.
If your medical certificate indicates that your CDL driving privilege must be accompanied by an FMCSA Skills performance Evaluation and/or an FMCSA waiver/exemption, then you must carry this documentation with you, along with your medical certificate, while operating CMV.
Note: Transportation with a CMV within state lines is considered interstate commerce if the origin and/or destination of the load crosses state lines.
Excepted interstate. Operates a commercial motor vehicle outside of Michigan, only for “excepted” purposes listed below. The medical documentation does not need to be provided to the Department of State. However, it must be in your possession when operating a commercial vehicle.
Note: Transportation with a CMV within state lines is considered interstate commerce if the origin and/or destination of the load crosses state lines.
Excepted Interstate Purposes:
49 CFR §390.3(f): State and federal transportation, occasional transportation of personal property not for compensation, transportation of human corpses or sick/injured persons, fire trucks and rescue vehicles, commercial vehicles designed or used to transport between 9 and 15 passengers (including the driver), transportation of propane winter heating fuel.
49 CFR §391.2: Farm custom operations, apiarian industries (beekeepers seasonally transporting bees), certain farm vehicle drivers.
49 CFR §391.68: Private motor carrier of passengers (non-business).
49 CFR §398.3: Driver of migrant workers.
Non-excepted intrastate. Operates a commercial motor vehicle only within Michigan (intrastate commerce). Your medical certificate does not have to be provided to the Secretary of State, however it must be in your possession when operating your Commercial motor vehicle. If your medical certificate must be accompanied by a Michigan Motor carrier waiver, then this documentation must be in your possession, along with your medical certificate, while operating your Commercial Motor vehicle.
Excepted intrastate. Operates a commercial motor vehicle only within Michigan (intrastate commerce) only for an excepted purpose listed below.
Excepted Intrastate Purpose:
MCL 480.15(2)-(5): A self-propelled implement of husbandry or an implement of husbandry being drawn by a farm tractor or another implement of husbandry, public utility, telephone, and cable television company service vehicles that do not meet the definition of a commercial motor vehicle in 49 CFR part 383, or a public utility service vehicle used in cases of emergency.
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