Navmc 10964 Form PDF Details

In the meticulous orchestration of military logistics and operations, the utility and management of government vehicles stand as a critical facet, underscored by the necessity for a standardized procedure to ensure that only qualified individuals operate such assets. The NAVMC 10964 form, known as the Application for Government Vehicle Operator's Permit, emerges as an essential document in this context. Its comprehensive layout is designed to streamline the application process for military personnel aspiring to operate government vehicles, thereby ensuring operational efficiency and safety. Through a series of sections, the form meticulously gathers personal information, driving history, and the results of various qualification tests ranging from physical and vision exams to specific driving skills assessment. Furthermore, it outlines the process for license action, including the issuance of new licenses, renewals, upgrades, or duplicates, and also delineates the classes of vehicles and special qualifications of the applicant. This form embodies a crucial mechanism in maintaining the professionalism and competency of vehicle operators within military operations, signifying its role not just as a bureaucratic necessity but as a cornerstone of operational readiness and safety.

QuestionAnswer
Form NameNavmc 10964 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnavmc 10964 updated, dod 11240 7800 fill, where to file form mvd 10964, dod form 10964

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APPLICATION FOR GOVERNMENT VEHICLE OPERATOR'S PERMIT (11240)

NAVMC 10964 (REV. 2­96) (EF) (Previous editions are obsolete)

SN: 0109­LF­064­7800 (Supersedes NAVFAC FORM 9­11240/10 FOR USMC use.)

PART I APPLICATION

 

1. NAME (LAST, FIRST, MIDDLE)

 

 

 

 

2. RANK

3. SSN

 

 

 

 

 

 

4. ORGANIZATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. SEX

 

6. HEIGHT

7. WEIGHT

8. EYE COLOR

9. HAIR COLOR

 

10. PLACE OF BIRTH

 

 

 

 

11. DOB

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAST DRIVING RECORD

 

 

 

 

 

 

 

 

 

 

12.

STATE OF ISSUE

 

 

13. LICENSE NUMBER

 

14. ISSUE DATE

15. EXP. DATE

16. CLASS OF VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17.

COMMANDING OFFICER'S SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I RECOMMEND THAT THIS INDIVIDUAL BE EXAMINED FOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

QUALIFICATION TO HOLD THE OF 346

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Signature)

 

 

 

(Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART II EXAMINATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.

QUALIFICATION TESTS (CHECK)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TEST

 

 

 

SAT

 

UNSAT

TEST

 

 

 

 

 

 

 

SAT

 

UNSAT

TEST

 

 

 

SAT

UNSAT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHYSICAL

 

 

 

 

 

 

 

HEARING

 

 

 

 

 

 

 

 

 

VISION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WRITTEN

 

 

 

 

 

 

 

REACTION TIME

 

 

 

 

 

 

 

 

 

SKILL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ROAD

 

 

 

 

 

 

 

DIRT/CROSS COUNTRY

 

 

 

 

 

 

 

 

 

SPECIAL QUALIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19. RESTRICTIONS: (List)

 

 

CHECK HERE IF NONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART III LICENSE ACTION

 

 

 

 

 

 

 

 

 

 

20.

CATEGORY (Check One)

 

 

 

 

 

 

 

 

 

21. CLASS OF LICENSE (Check all that apply)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NEW

RENE

 

 

 

UPGRADE

 

DUPLICATE

COMMERCIAL

 

 

TACTICAL

 

 

BUS

 

TRACTOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22.CLASSES OF VEHICLES (Check all that apply)

SEDANS/STATION WAGONS

 

TRUCKS TO

 

TON

 

TRUCK­TRACTOR TO

 

TON

 

BUSSES TO

 

PASS

 

 

 

 

 

 

 

 

 

 

 

 

 

23. SPECIAL QUALIFICATIONS:

SEMITRAILER REFUELER

EMERGENCY VEHICLE

RECOVERY VEHICLE

TRUCK WITH FULL TRAILER

HAZARDOUS MATERIALS

OTHER (SPECIFY)

24. VEHICLE/EQUIPMENT CLASSES QUALIFIED TO OPERATE LIST:

25. SIGNATURE OF LICENSING EXAMINER

 

 

I CERTIFY THAT THIS INDIVIDUAL IS QUALIFIED TO OPERATE

 

 

THE ABOVE LISTED EQUIPMENT.

(Signature)

(Date)

 

26. LICENSE # ISSUED

27. DATE ISSUED

28. EXPIRATION DATE

29. SIGNATURE OF LICENSING OFFICER

DATE

PART IV RECORDING ACTION

30. RECORDING OFFICER'S SIGNATURE

 

I CERTIFY THAT ALL THE INFORMATION IN BLOCKS 19, 20, 23, 24, 26,

27,

AND 28 HAVE BEEN ENTERED ON PAGE 11 OF THE INDIVIDUAL'S SRB/OQR

 

SIGNATURE

DATE

Designed Using FormFlow 2.15, HQMC/ARAE, Apr 98