Restricted License Form PDF Details

Are you in need of a restricted license? Whether it’s in order to go to and from work, attend medical appointments, or for another necessary purpose, acquiring a restricted license can be an important milestone on the road to getting back behind the wheel. This blog post will explain what exactly a restricted license is, why one might consider applying for one, and provide step-by-step instructions on how to properly fill out the required form. Keep reading if you think this could be beneficial for your situation!

QuestionAnswer
Form NameRestricted License Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnd restricted request, nd temporary, how to fill out a reference check form, temporary restricted license north dakota

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TEMPORARY RESTRICTED LICENSE REQUEST

North Dakota Department of Transportation, Drivers License

SFN 2254 (6-2019)

GENERAL INFORMATION ABOUT TEMPORARY RESTRICTED LICENSES

•Minimum age requirement to obtain Temporary Restricted License is 18 years of age.

•Temporary Restricted License is for Class D or M only (You may be required to retest if your driving privileges have been revoked or expired over 1-year).

•Reinstatement fee must be paid.

•Investigations are conducted by Driver's License Division to determine the validity of information submitted.

MAIL, EMAIL, OR FAX COMPLETED FORM TO: DRIVERS LICENSE DIVISION

NORTH DAKOTA DEPARTMENT OF TRANSPORTATION 608 E BOULEVARD AVE

BISMARCK ND 58505-0750 drs@nd.gov

Fax: (701)328-2435

INSTRUCTIONS ON COMPLETING THE APPLICATION FORM

All applicants must complete parts I & II. Part III must be completed by your employer. Part IV must be completed if you are self employed. Part V must be completed if you are requesting driving time to/from school. Part VI must be completed when participating in the 24/7 Sobriety Program to qualify for a Temporary Restricted License. Part VII must be completed if you are requesting driving time to attend counseling/treatment sessions. Parts I and VIII to be completed only if you are updating your employment or address information on your Temporary Restricted License.

I. APPLICANT'S CERTIFICATION

I understand that a temporary restricted license is limited (restricted) to driving for employment and supporting life maintenance needs. Life maintenance needs is defined as the necessity to prevent the substantial deprivation of the education, medical, or nutritional needs of myself or an immediate family member. Driving outside these restrictions is unlawful. I acknowledge that if I am employed or seeking treatment outside of North Dakota that it is my responsibility to check with law enforcement in that state to ensure that state recognizes the use of this temporary restricted license. Under the penalty of perjury, I certify that the information contained in this application is true and correct. I understand failure to properly complete this application in its entirety will void my request. I further certify that I have motor vehicle liability insurance coverage.

Applicant's Signature

Date

DLN

II. APPLICANT'S INFORMATION

Full Name

 

 

 

Date of Birth

 

 

 

 

 

 

Resident Address (Not PO Box)

City

State

ZIP Code

Telephone Number

 

 

 

 

 

 

Mailing Address (If different then resident address)

City

 

State

ZIP Code

 

 

 

 

Explain the reason you need a temporary restricted license (employment, 24/7 Sobriety Program)

 

 

 

 

 

 

 

 

III. EMPLOYER'S INFORMATION - TO BE COMPLETED BY EMPLOYER

Employer

Name of Business

 

 

 

 

 

 

Business Address (Not PO Box)

City

State

ZIP Code

 

 

 

 

Print Name of Supervisor

 

Telephone Number

 

 

 

 

Signature of Supervisor

 

Date

 

 

 

 

 

IF YOU HAVE ADDITIONAL EMPLOYMENT, YOU WILL NEED TO COMPLETE SECTION III FOR EACH EMPLOYER.

SFN 2254 (6-2019)

Page 2 of 2

IV. SELF-EMPLOYED INFORMATION - YOU MAY BE ASKED TO PROVIDE PROOF OF SELF EMPLOYMENT

Name of Business

Type of Business

 

 

 

 

 

 

Address

City

State

ZIP Code

 

 

 

 

V. SCHOOL INFORMATION

Name of School

Telephone Number

 

 

 

 

 

 

Address

City

State

ZIP Code

 

 

 

 

School Administrator's Signature

 

 

Date

 

 

 

 

A COPY OF APPLICAN'TS CLASS SCHEDULE MUST BE KEPT IN YOUR VEHICLE

VI. PARTICIPATION IN THE 24/7 SOBRIETY PROGRAM

I confirm that I am participating in the 24/7 Sobriety Program. I understand that by participating in the 24/7 Sobriety Program, I must provide Driver's License Division proof of participation by means of a Bond Order from the court or other proof of participation acceptable to the director.

Applicant's Signature (needed only if participating in the sobriety program)

Date

VII. COUNSELING/TREATMENT INFORMATION

Name of Counseling Center

Telephone Number

Business Address (Not PO Box)

City

State

ZIP Code

VIII. UPDATING INFORMATION ONLY

PLEASE CHECK THE APPROPRIATE BOX(S)

Please update the following information and mail a revised Temporary Restricted License with the revised information.

I have had a change of:

 

Address Only

 

Employment Only

 

 

Address and Employment

 

Additional Job

 

 

 

 

 

 

 

 

Name

 

 

 

 

Telephone Number

 

 

Address (Not PO Box)

City

State

ZIP Code

Name of Employer

Telephone Number

Business Address (Not PO Box)

City

State

ZIP Code

Signature of Employer

Date

PLEASE READ IMPORTANT INFORMATION BELOW

1.If you have had 2 alcohol offenses within 5 years and you are not 1-year violation free, you must be in the 24/7 Sobriety Program to qualify for the TRL.

2.All TRL's are issued for a period not to exceed six months. If your privileges are suspended for longer than six months, the TRL will be automatically renewed as long as you still meet the necessary requirements.

3.If your driving privileges are suspended, revoked, or canceled in any other state, you will not qualify for a TRL.

4.Your Temporary Restricted License will be canceled if:

•You cancel your SR-22 (as long as it is still required)

•You receive another criminal traffic offense

•You are found in non-compliance with the 24/7 Sobriety Program (if it is required)

•You terminate your alcohol treatment (if treatment is required)

•Our office is notified you have unpaid court fines or unpaid fines in another jurisdiction

5.If you have not met the requirements within 3 months of submitting your initial application, you will be required to submit a new application.

6.You must notify our office within 10 days if you have had a change of employment and an updated temporary restricted license will be issued.

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As a way to complete this form, make sure you enter the required information in every single field:

1. To get started, while completing the how to nd temporary, begin with the page that features the subsequent fields:

Learn how to prepare how to fill out a reference check form part 1

2. Once the previous part is finished, it is time to add the necessary details in I understand that a temporary, Applicants Signature, Date, DLN, II APPLICANTS INFORMATION, Full Name, Date of Birth, Resident Address Not PO Box, City, State, ZIP Code, Telephone Number, Mailing Address If different then, City, and State so that you can progress further.

Filling out section 2 in how to fill out a reference check form

3. This part is easy - complete every one of the form fields in Signature of Supervisor, Date, and IF YOU HAVE ADDITIONAL EMPLOYMENT in order to complete this part.

how to fill out a reference check form writing process outlined (stage 3)

4. Filling out SFN Page of IV SELFEMPLOYED, Name of Business, Address, V SCHOOL INFORMATION, Name of School, Type of Business, City, State, ZIP Code, Telephone Number, Address, City, State, ZIP Code, and School Administrators Signature is key in this fourth part - be sure to don't rush and fill out every field!

Writing section 4 in how to fill out a reference check form

When it comes to Name of Business and ZIP Code, be certain that you do everything correctly in this current part. Both these are the key fields in the form.

5. When you approach the finalization of this form, there are just a few more things to do. Particularly, Business Address Not PO Box, City, State, ZIP Code, VIII UPDATING INFORMATION ONLY, PLEASE CHECK THE APPROPRIATE BOXS, Please update the following, Address and Employment, Additional Job, Address Only, Employment Only, Name, Telephone Number, Address Not PO Box, and City should be filled in.

Part number 5 of completing how to fill out a reference check form

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