Form Ds 876 PDF Details

Within the sphere of commercial driving in New York State, the DS-876 form emerges as a pivotal document, central to ensuring that bus drivers meet the rigorous standards set by the Department of Motor Vehicles. This form serves as an application for those seeking certification as Article 19-A Certified Examiners, professionals who play a crucial role in maintaining road safety by evaluating the driving skills of bus drivers. Applicants must navigate a series of prerequisites, including holding a valid commercial driver license with relevant endorsements and possessing an acceptable driving record. Moreover, the application process demands a demonstration of considerable experience both in driving and in evaluating driving abilities, alongside specific educational milestones. Applicants must furnish proof of their qualifications, from driver training and traffic safety coursework to a detailed account of their professional experience. The DS-876 does not merely form a bureaucratic hurdle but stands as a testament to the commitment of the State of New York to uphold the highest standards in commercial driving, ensuring that those tasked with evaluating bus drivers bring a wealth of expertise and integrity to their role.

QuestionAnswer
Form NameForm Ds 876
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesds876 ds 876a form

Form Preview Example

DS-876 (11/13)

NewYorkStateDepartmentofMotorVehicles

BUS DRIVER UNIT

APPLICATION FOR ARTICLE 19-ACERTIFIED EXAMINER

www.dmv.ny.gov

INSTRUCTIONS/INFORMATION

●Completepage1andpage2ofthisformandsigntheAffirmationsection.Pleaseprintclearly.

●Inordertobecertified,youmusthaveavalidcommercialdriverlicensewithappropriateendorsements.Youmustbeproperlylicensed intheclassinwhichyouwillbetestingdrivers.

●IfyourcommercialdriverlicensewasissuedbyastateotherthanNewYork,attacharecentcertifieddriverlicenseabstractfromthe statethatissuedyourlicense.

●Youmusthaveanacceptabledrivingrecord(nomorethan6pointsaccumulatedonyourrecordwithinthepreceding18-monthperiod).

●Mailthiscompleted,signedformandrequireddocumentationtothefollowingaddress:

BusDriverUnit

NYSDepartmentofMotorVehicles

6EmpireStatePlaza Room136B

Albany,NY 12228

Ifyourapplicationmeetsinitialqualificationstandards,youwillbenotifiedbymailtocontactaMotorVehiclesTestingandInvestigation UnittoscheduleaCertifiedExaminerqualifyinginterviewthatwillincludeawrittentest,avisiontest,andaroadtest.Donotcontactthe

MotorVehiclesOfficeuntilyoureceivethatnotice.

APPLICANT INFORMATION

Driver’s Last Name

First Name

Street Address

Middle Initial Date of Birth (mm/dd/yyyy)

/ /

oMale oFemale

City

State

Zip Code

 

 

County

ID Number from Driver License

State

License Class

Endorsements

Restrictions

Expiration Date

Daytime Telephone No.

()

E-mail Address

Certification Class Requested - Check Class of vehicle in which you will be testing.

o Class B o Class C

Freelance - Occasionally DMV will get requests for the names of Certified Examiners who are available to do independent examiner work.

Do you want to be included on such a list? o Yes o No

Name of Current 19-A Carrier Employer

Federal Employer ID Number (FEIN)

Article 19-A Business ID Number

PAGE 1 OF 2

DS-876 (11/13)

EXPERIENCE

I have a minimum of 2 years experience in driver training and the evaluation of the driving ability of others. (Provide information about

youremployer(s)below.Attachaseparatesheetifyouneedmorespacetodocumentyourexperience.)

Employer Name and Address

Dates Employed

 

Class of

 

 

License Held

 

From:

To:

 

 

1.

2.

AND

I have a minimum of 18 months experience in the last 3 years while employed by a 19-A carrier in the operation of the type of vehicle

in which I will be testing. (Provide information about your employer(s) below. Attach a separate sheet if you need more space to document yourexperience.)

Employer Name and Address

Dates Employed

 

Class of

 

 

License Held

 

From:

To:

 

 

1.

2.

EDUCATION

In addition to the above experience, you MUST have completed one of the following courses. Check the box that applies to you.

o Ihavesuccessfullycompletedacollege-levelcoursewithaminimumof4credithoursindrivereducationinstruction. (Attachacopyofyourtranscript.)

OR

o IhavesuccessfullycompletedaDMV-approvedcourseindrivertrainingandtrafficsafetyfor19-ACertifiedExaminers. (Attachacopyofyourcoursecertificate.)

EXCEPTION

Youmaybeabletoprovidespecialaffidavitsifyoudonothaveaminimumof18monthsexperienceinthelast3yearswhileemployedbya 19-Acarrierintheoperationofthetypeofvehicleinwhichyouwillbetesting.Attachdocumentationoutliningyourexperienceandtraining andanyotherspecialcircumstancewhichmightqualifyyoutobecomeacertifiedexaminer.TheBusDriverUnitwillreviewyour informationanddeterminewhetheritisacceptable.

AFFIRMATION

IherebymakeapplicationtotestdriversinaccordancewiththemandatesofArticle19-AoftheNewYorkStateVehicleandTrafficLaw. To the best of my knowledge, the information provided is true and correct. I understand that any false statement I make on this application is punishableasamisdemeanorunderSection392oftheNewYorkStateVehicleandTrafficLaw.

Applicant’sSignature: ➧_______________________________________________________________

Date: ____________________

 

 

CARRIER ENDORSEMENT

 

 

 

IendorsethisapplicanttobeaCertifiedExaminerformycompany.

 

Current19-AEmployerName(pleaseprint):__________________________________________________________________________

Current19-AEmployer’sSignature: ➧____________________________________________________

Date:_____________________

PAGE 2 OF 2

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