Form Mv 523 PDF Details

The MV-523 form plays a crucial role in the certification process for driving school instructors in New York State, outlining various application requirements and procedural steps as mandated by the New York State Department of Motor Vehicles (DMV). This comprehensive document serves multiple purposes, including applications for an original instructor's certificate, renewals for one or two years, addition of new endorsements, and changes in vehicle class endorsements, with fees varying based on the requested service. It necessitates detailed personal information, driving and criminal history, educational background, and employment details to ensure the applicant meets all criteria for becoming a qualified driving instructor. Furthermore, it underscores the importance of accuracy and honesty, as any false statement could result in revocation of the certification. With all fees being nonrefundable and specific documentation required for each type of application, the form is designed to streamline the certification process while upholding the standards of driving education in the state. Through clear instructions and a checklist for required documents, the MV-523 form aids applicants in navigating the complex certification landscape, attempting to strike a balance between rigorous standards for public safety and an efficient, accessible pathway for prospective instructors.

QuestionAnswer
Form NameForm Mv 523
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesNYS, nysdmv, 30-hour, degeneracy

Form Preview Example

CHECKWHAT YOU NEED

ALL FEES ARE NONREFUNDABLE

OriginalInstructor’sCertificate($10.00)

One-Year Renewal ($10.00)

Two-Year Renewal ($20.00)

Additional Certificate ($0)

Classroom Endorsement ($0)

ChangeofVehicleClassEndorsement($0)

New York State Department of Motor Vehicles

APPLICATION FOR DRIVING SCHOOL

INSTRUCTOR CERTIFICATE

(Please type or print clearly. Applications completed illegibly

or left incomplete will delay processing.)

www.nysdmv.com

FOR OFFICE USE ONLY

Instructor Class ______________ Classroom

Endorsement

Certificate No. ________________________________

Date

/

/

Expiration

/

/

Issued:

Date:

 

 

 

 

 

 

 

 

Denial No. _____________

Date

/

/

Denied:

 

Last Name

First

 

M.I.

 

Social Security Number

 

Date of Birth (Mo./Day/Yr.)

Sex

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F

Mailing Address (Street & No.)

 

 

 

 

 

Place of Birth

 

 

 

 

 

 

Driver LIcense ID No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

State

Zip Code

 

 

 

License Class

Expiration Date

 

Years of Driving Experience

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver Education Instructor’s Certificate (MV-283) number (attach copy)

Have you had one year of experience as an in-car instructor? No

Yes

 

 

 

 

 

 

If “Yes”, Name of Driving School.

 

 

 

 

 

 

 

 

 

 

 

 

No. of hours: _________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Address of Driving School

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

sending application:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What type(s) of vehicles will you use for instruction? Auto

Bus

Motorcycle

 

Tractor-Trailer

Truck

 

 

 

 

 

 

Note: Section 5 of the NYS Tax Law requires the Department of Motor Vehicles to provide Social Security numbers to the NYS Department of Taxation and

 

 

 

Finance upon request.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You must answer ALL the following questions. Questions answered “Yes” must be explained on page 2.

 

 

 

CHECKONE :

YES

NO

1.

Have you ever been convicted of any traffic violations (not parking violations)?

 

 

 

 

 

 

 

 

 

 

 

 

2.

Has your license to drive (or your driving privilege) ever been refused, cancelled, suspended or revoked in New York or any other state?

3.

Have you ever been convicted of any crime or felony involving violence, dishonesty, deceit, indecency, degeneracy or moralturpitude?

4.

Have you ever been convicted of perjury or of making any false statements relating to any part of the New York Vehicle and Traffic Law?...

5.

Are you presently involved with any charges or court proceedings relating to the matters stated in questions1, 3 or 4?

....................................

 

 

 

 

6.

Have you ever had a driving school and/or instructor’s certificate denied, cancelled, suspended or revoked?

 

 

 

 

 

 

 

 

 

7.

Have you been an instructor for a Point Insurance Reduction Program within the last 12 months?

 

 

 

 

 

 

 

 

 

8.

Have you given driver training instructions for compensation within the last 12 months?

 

 

 

 

 

 

 

 

 

 

 

9.

Do you have any physical impairment that could hinder your ability to perform the duties of a driving instructor?

 

 

 

 

10.

Have you ever been known by any name other than the one shown on this application?

 

 

 

 

 

 

 

 

 

 

 

 

EDUCATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you:

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

School

 

 

 

 

received a high school diploma or GED (General Educational Development)?

 

____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(If “Yes,” attach copy if you are an original applicant.) . . . .

. . . . . . . . . . . .

. . . . . . .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date Issued

completed a DMV approved course in traffic safety for driving school

 

instructors (30-hour basic)? (If “Yes,” attach copy of certificate.) . . . . . . . . . . . . . . .

____________

 

 

 

completed a DMV approved advanced course in teaching techniques &

 

Date Issued

 

 

 

 

 

 

 

methodology?

(If “Yes,” attach copy of proof of completion.). . . . . . . . . . . . . . . . . .

____________

 

 

 

 

 

 

 

 

 

 

Date Issued

 

 

 

 

 

 

EMPLOYMENT - List employment experience for last 5 years, most recent first. Do not include current employment in a commercial driver training school.

Original applicants must complete this section:

 

 

 

 

 

 

 

 

 

 

Name of Firm

 

 

 

 

Address of Firm

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kind of Work

 

 

Dates Employed

 

 

 

 

Reason for Leaving

 

 

 

 

;

 

To

 

 

 

 

 

 

 

 

 

From

 

 

 

 

 

 

 

Name of Firm

 

 

 

 

Address of Firm

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kind of Work

 

 

Dates Employed

 

 

 

 

Reason for Leaving

 

 

 

 

;

 

To

 

 

 

 

 

 

 

 

 

From

 

 

 

 

 

 

 

Name of Firm

 

 

 

 

Address of Firm

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kind of Work

 

 

Dates Employed

 

 

 

 

Reason for Leaving

 

 

 

 

From

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR OFFICE USE ONLY

 

 

 

 

 

Approved

Disapproved

By: _____________________________________________________________ Date__________________

 

 

 

 

 

 

 

 

 

 

 

 

PAGE 1 OF 2

 

 

 

New York State Department of Motor Vehicles

 

 

 

CASHIER’S RECEIPT FOR THE BUREAU OF DRIVER TRAINING PROGRAMS

Received from

____________________________________________________________________________________________

Address

__________________________________________________________________________________________________

Amount

__________________________________________________________________________________________________

 

 

MV-523 (2/09)

 

The validation number on this receipt is the same as the number stamped on the application.

 

 

 

 

Instructor Certificate No.

Social Security Number _________________________________________

EXPLANATIONS

Identify by name and address all driving schools at which you have worked in the past 5 years; list most recent first.

If you answered “Yes” to any questions on the front of this form, give the details below. Identify the number of the question being answered.

The applicant agrees that:

1.if I end my employment with the driving school, I will immediately surrender my instructor’s certificate to the school. (Theschoolisrequiredtoforward thecertificate totheDMV).

2.if I become employed by another driving school, I will apply for a new instructor’s certificate for that school.

3.if my driver license is suspended or revoked, my instructor certificate is not valid, and I must surrender the certificate toDMV.

4.if DMV determines that I am not entitled to the certificate, I will immediately surrender my certificate to the driving school. (Theschoolis requiredtoforwardthecertificate totheDMV).

5.if I lose my certificate, I will report the loss immediately, in writing, to the DMV.

6.I will carry the instructor’s certificate at all times while giving driving instructions or when I am accompanying a studentto a DMV road test.

7.the instructor’s certificate will be valid only to give driving and/or classroom instruction in the course of my employment or association with the driving school identified on this application.

I affirm that I have read this entire application; that I know its contents and that all answers, statements and all other matters contained in it are true. I understand that any false statement will result in the revocation of any driving school instructor’s certificate that has been issued to me. NOTE: It is a criminal offense to knowingly make a false statement or conceal a material fact in this application. To do so will result in the revocation of your instructor certificate.False statements are punishable under Section 210.45 of the Penal Code.

Applicant’s Signature______________________________________________________ Date _____________________________

This application must be signed by an authorized official of the driving school.

Signature of Driving

School Official_____________________________________________________ Title________________________________ Date __________________

WHATISNEEDED:Findthesectionbelowthatappliestotheactionyouwanttotake.Itliststhedocumentsyoumustprovidetocompleteyourapplication.

AN ORIGINAL INSTRUCTOR CERTIFICATE

 

 

 

 

 

 

A $10 check or money order payable to the Commissioner of Motor Vehicles

 

 

 

Two photographs no more than 30 days old

 

ATTACH

 

 

PHOTO(S)

 

A copy of the applicant’s high school diploma or General Educational Development (GED)

 

 

 

 

 

 

 

 

A copy of the applicant’s written and road sign test

 

 

 

A copy of the applicant’s road test results for the type of vehicle used in instruction

 

Photograph(s) must have been

 

taken within past 30 days and

A copy of the Visual Acuity Report (form MV-619) completed by applicant’s health care professional

 

 

should be 1 7/8’’ wide x 2’’ long,

A RENEWAL INSTRUCTOR CERTIFICATE

 

 

and must be a true likeness

For a one-year renewal, send a $10 check or money order payable to the Commissioner of Motor Vehicles

 

showing only the shoulders, neck

For a two-year renewal, send a $20 check or money order payable to the Commissioner of Motor Vehicles

 

anduncoveredhead.

Two photographs no more than 30 days old

Proof of completion of the 30-Hour Basic Course for the preparation of professional driving school instruction(THE 30-HOUR BASIC COURSE

MUST BE COMPLETED WITHIN A YEAR FROM THE DATE THE ORIGINAL INSTRUCTOR CERTIFICATE ISISSUED)

CLASSROOM ENDORSED INSTRUCTOR CERTIFICATE

Send a copy of the required 30-Hour Basic Course completion certificate

Send proof of completing an approved advanced program in Teaching Techniques and Methodology(ONE YEAR OF BEHIND-THE-WHEEL

INSTRUCTION WILL ALSO BE NECESSARY FOR CLASSROOM ENDORSEMENT)

Mail completed applications to: NYS Department of Motor Vehicles, Bureau of Driver Training Programs, 6 ESP, Room 412, Albany NY 12228.

MV-523 (2/09)

PLEASE ALLOW 6-8 WEEKS FOR PROCESSING

PAGE 2 OF 2

How to Edit Form Mv 523 Online for Free

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Concentrate when filling out this document. Ensure that every field is done properly.

1. Whenever filling in the MV-619, make certain to complete all of the necessary blank fields in their corresponding area. It will help to speed up the work, allowing for your information to be handled fast and appropriately.

Filling out section 1 in New_York

2. Just after filling in the previous section, go to the subsequent step and fill out the necessary details in these blank fields - You must answer ALL the following, EDUCATION Have you, Yes No, School, received a high school diploma or, If Yes attach copy if you are an, completed a DMV approved course, instructors hour basic If Yes, completed a DMV approved advanced, methodology If Yes attach copy of, Date Issued, Date Issued, Date Issued, EMPLOYMENT List employment, and Address of Firm.

The way to fill in New_York portion 2

Be very mindful while filling in EMPLOYMENT List employment and methodology If Yes attach copy of, because this is where a lot of people make a few mistakes.

3. This next stage is going to be straightforward - fill in all of the blanks in Kind of Work, Name of Firm, Kind of Work, Dates Employed From To, Address of Firm, Dates Employed, From To, FOR OFFICE USE ONLY, Reason for Leaving, Reason for Leaving, Approved Disapproved, By Date, PAGE OF, CASHIERS RECEIPT FOR THE BUREAU OF, and New York State Department of Motor to finish this segment.

Filling in segment 3 of New_York

4. This next section requires some additional information. Ensure you complete all the necessary fields - Social Security Number, EXPLANATIONS Identify by name and, If you answered Yes to any, The applicant agrees that, if I end my employment with the, the certificate to the DMV, if I become employed by another, if my driver license is suspended, if DMV determines that I am not, and required to forward the - to proceed further in your process!

the certificate to the DMV, if my driver license is suspended, and EXPLANATIONS Identify by name and in New_York

5. Since you get close to the conclusion of this document, you'll notice a few more things to do. Particularly, I affirm that I have read this, Signature of Driving School, This application must be signed by, WHAT IS NEEDED Find the section, AN ORIGINAL INSTRUCTOR CERTIFICATE, A check or money order payable, A RENEWAL INSTRUCTOR CERTIFICATE, ATTACH PHOTOS, Photographs must have been taken, For a oneyear renewal send a, MUST BE COMPLETED WITHIN A YEAR, CLASSROOM ENDORSED INSTRUCTOR, Send a copy of the required Hour, INSTRUCTION WILL ALSO BE NECESSARY, and Mail completed applications to NYS must be filled out.

Tips on how to fill out New_York step 5

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