Mv3001 Details

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QuestionAnswer
Form NameWisconsindmv Mv3001
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesdmv wisconsin, wisconsin dmv, wisconsindmv gov mv 3001, wisconsindmv gov mv

Form Preview Example

Information about the Wisconsin

Driver License (DL) Application (form MV3001)

You will need to visit a DMV service center and present an MV3001 application when you:

apply for an original or duplicate* driver license or instruction permit

renew an existing driver license

apply for an occupational license

An application may only be submitted through the mail if you are unable to renew or obtain a duplicate driver license because you are a Wisconsin resident who is temporarily out-of-state.

More information about:

renewing when out of state

fees

applying for a license

*Note: You may be eligible to order a duplicate driver license online rather than visit a DMV service center. See our online duplicate driver license application for further information.

WISCONSIN DRIVER LICENSE (DL) APPLICATION

 

 

 

 

 

An unexpired Wisconsin

Wisconsin Department of Transportation

 

 

driver license is acceptable

MV3001 7/2021 Ch. 343 Wis. Stats.

Clear Form

 

photo ID for voting.

 

 

(s. 5.02(6m) Wis. Stats.)

 

 

 

Acceptable proof of name and date of birth, legal presence, identity and Wisconsin residency are required. Please see DOT publication BDS316 or wisconsindmv.gov/dl-docs for a list of acceptable documents.

ALL applicants, complete the top section on back.

If under age 18, also complete the ‘UNDER AGE 18’ section below.

CDL applicants, complete the ‘CDL APPLICANT ONLY’ section below.

Your Federal Medical Certificate is required unless you drive a school bus or drive for a political subdivision.

DONOR  Check the box if you wish to help others by donating your organs, tissue and eyes upon your death. Your gift will be used to save and improve lives through transplantation, therapy, research or education. If you are at least 18, checking the box indicates your legal consent for donation. You do

not have to answer this question to obtain a license.

ADA  The Wisconsin Department of Transportation complies with the Ameri- cans with Disabilities Act (ADA).

INVISIBLE DISABILITY  Notice to law enforcement form: wisconsindmv.gov/inv-dis or at DMV Service Centers.

SOCIAL SECURITY NUMBER (SSN)  If you have a SSN, you must provide it (s. 343.14(2)(bm) Wis. Stats.). Your SSN may be used for purposes authorized by law and to link your driver license and vehicle registration records. Your SSN must correspond with the number issued by the Social Security Administration. Federal regulation 49 CFR, Part 383.153 requires a

SSN for commercial driver license privileges.

COMMERCIAL DRIVER LICENSE APPLICANT ONLY

NOTICE TO MALES AGE 18–25 By submitting this application, you

consent to be registered with the Selective Service System, if required

by Federal law. You also authorize the Department of Transportation to

forward any information contained in this application that is requested by the

Selective Service System for the purpose of registering you as provided in s. 343.14(2)(em) and s. 343.234 Wis. Stats.

WARNING  Any applicant for a driver license who presents fraudulent

or altered documents or makes a false statement to the issuing officer or agency, may be subject to a fine of not more than $1,000, imprisonment for

not more than six months or both. The driver license privilege may also be revoked for one year. (s. 343.14(5) Wis. Stats.)

OPT OUT  Under Wisconsin open records laws, WisDOT must provide

information from its records to requesters. If you do not want your name and address included in requests we receive for ten or more records, you may ask

WisDOT to withhold your name and address from those lists by checking the box on the application.

INSURANCE  No person may operate a motor vehicle in Wisconsin unless the owner or driver of the vehicle has liability insurance in effect for the vehicle being operated and carries proof of insurance whenever driving. Failure to have insurance could result in a fine up to $500. Refer to s. 344.61- 344.65 Wis. Stats. for full details.

If applying for a HAZMAT endorsement (HME), complete Driver License Hazardous Materials Endorsement Application, form MV3735. If applying for a school bus endorsement, complete School Bus or Alternative Vehicle License Information Request, form MV3740.

1.

 

In the past 5 years, have you had a loss of

YES

NO

6. Is the vehicle you will be operating equipped

YES

NO

 

 

consciousness or muscle control caused by a

 

with air brakes?

 

 

neurological condition, for example, seizure disorder?

7. Do you meet all the driver qualifications as required

 

 

 

 

 

YES

NO

2.

 

In the past 2 years, have you taken insulin

YES

NO

 

by 49 CFR 391 to operate a commercial vehicle?

 

 

If not, see Motor Carrier Safety FAQs in the Wisconsin

 

 

 

 

to control a diabetic condition?

 

 

 

 

 

 

 

 

Commercial Driver’s Manual.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

In the past 2 years, have you taken oral

YES

NO

8. School Bus, CDL Instructional Permit and

YES

NO

 

 

medication to control a diabetic condition?

 

New CDL Class/Endorsement Applicants Only.

 

 

 

 

 

 

Is the vehicle in which you will take the commercial

 

 

4.

 

Is your hearing impaired? (hard of hearing)

YES

NO

 

driver license skills test representative of the type

 

 

 

 

 

 

of vehicle you will operate or intend to operate?

 

 

 

 

 

 

 

 

 

5.

Have you held a valid operator's license in the

YES

NO

9. School Bus Applicants Only.

YES

NO

 

Have you been convicted of an offense identified

 

last 10 years from any jurisdiction (state) other

 

on School Bus or Alternative Vehicle License

 

 

 

than Wisconsin?

 

 

 

Information Request, form MV3740 in Wisconsin

 

 

 

If yes, list all states:

 

 

 

or any other jurisdiction? If yes, list date and place:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER LICENSE APPLICANT UNDER AGE 18 ONLY

Applicant Certification: I certify that in the past six months I have not

 

Sponsor Certification: As the adult sponsor under s. 343.15 Wis. Stats.,

been ticketed for a moving violation that has or may result in a conviction.

 

I accept liability and verify that the minor is not a habitual truant and meets the

I understand that falsifying this statement will result in the cancellation of

 

educational requirements for licensure. If required for this application, I certify

my probationary license. Applicant Signature – REQUIRED.

 

that the applicant has accumulated at least 50 hours of driving experience,

 

 

10 of which were at night.

 

 

 

 

Minor Name – Print

 

 

X

 

 

 

 

School Certification: I certify that this applicant is enrolled in approved

 

Sponsor Name – Print

Relationship to Applicant

behind-the-wheel training which begins no later than 60 days from date signed.

 

 

 

 

 

 

 

 

 

School ID Number School Name

 

Sponsor Wisconsin DL/ID Number

Sex

Birth Date (mm/dd/yyyy)

 

 

 

 

 

 

 

X

 

Official WisDOT Test Results (line out if not used)

(Sponsor Signature – Must be Witnessed by DMV Agent or Notarized)

Knowledge Test

Highway Sign Test

State of Wisconsin County of

Subscribed and sworn to before me on this date

Pass       Fail

Pass       Fail

 

 

X

 

X

 

(Authorized School Official/Instructor Signature)

(Date Signed)

(DMV Authorized Agent or Notary Signature)

(My Commission Expires)

 

 

DO NOT Use Notary Seal

 

 

WISCONSIN DRIVER LICENSE (DL) APPLICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

An unexpired Wisconsin

 

 

 

 

 

Wisconsin Department of Transportation

MV3001

7/2021

Ch. 343 Wis. Stats.

 

 

 

driver license is acceptable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clear Form

 

 

Print

 

 

 

photo ID for voting.

 

 

 

 

 

 

 

 

 

 

 

 

ALL APPLICANTS – Please Print

 

 

 

 

 

 

 

 

 

 

 

 

(s. 5.02(6m) Wis. Stats.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security Number

 

 

 

 

 

 

 

 

Applicant Name – First, Middle, Last

 

 

 

 

 

 

 

 

Birth Date (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residence Address – Street

 

 

 

 

 

 

 

 

 

 

 

Apt #

 

City

 

 

 

 

State

 

 

 

 

 

 

 

 

 

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address – ONLY IF DIFFERENT from Residence

Apt #

 

City

 

 

 

 

State

 

 

 

 

 

 

 

 

 

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex

Race

 

Eyes

 

 

 

 

Hair

Weight

 

 

 

 

 

 

 

 

 

Height

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Former Name (if changed since last license or ID card)

 

 

 

 

 

 

Reason for Name Change

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Marriage Divorce Other List:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Do you wish to register to be an organ, tissue and eye donor?

YES

7. Will you donate $2 to organ, tissue and eye donation efforts?

 

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. OPT OUT – Do you wish to have your name and address

YES

8. Do you need glasses or contact lenses for driving?

 

YES NO

 

 

 

 

 

withheld from lists WisDOT sells?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. I am a veteran registered with WDVA and wish to have my

YES

9. Do you have any physical limitations which interfere with

 

YES NO

 

 

 

 

 

veteran status indicated on my driver license. (DMV is

 

 

 

 

your ability to perform the normal tasks associated with

 

 

 

 

 

 

 

 

required to verify your status with WDVA)

 

 

 

 

 

 

operating a motor vehicle?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, have you successfully passed a road test with this

 

YES NO

 

 

 

4. Has your license, ID card or operating privilege ever been

YES NO

 

 

 

 

 

 

revoked, suspended, cancelled, disqualified or denied?

 

 

 

 

condition?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, list date and place:

 

 

 

 

 

 

 

 

10. In the past year have you had a loss of consciousness or

 

YES NO

 

 

 

 

5. Have you been convicted of operating while intoxicated

 

 

YES NO

muscle control caused by any of the following conditions?

 

 

 

 

 

 

 

 

OUTSIDE of Wisconsin?

 

 

 

 

 

 

If yes, check condition(s) and list date(s):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, give date and place:

 

 

 

 

 

 

 

Traumatic Brain or

Muscle or

 

 

 

Seizure

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. Do you hold a valid driver license/identification card from

 

 

YES NO

Head Injury (2)

Nerve (2)

 

 

 

Disorder (4)

Heart (6)

 

 

 

 

 

 

Stroke (2)

Mental (3)

 

 

 

Diabetes (5)

Lung (7)

 

 

 

 

 

another state/country?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, list:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Check ONLY ONE of the following three boxes.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Years of licensed driving experience in the United States, its

 

 

I certify that I am a:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

territories and Canada. List:

 

 

 

 

 

 

 

U.S. Citizen

Temporary Visitor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Permanent or Conditional Permanent Resident

 

 

 

 

 

 

 

 

 

 

I understand that I must surrender for cancellation any driver license or identification card previously issued by another state before I may be issued a driver license or identification card in the State of Wisconsin. The State of Wisconsin will notify the other state that my driver license or identification card is

surrendered and cancelled, and that I have been issued a Wisconsin license or identification card. (ss. 343.11(1) and (2), and 343.50(1)(b) Wis. Stats.) I certify

that the information on this application is true under penalty of perjury and I am a resident of Wisconsin. (s. 343.14(5) Wis. Stats.)

X

 

 

 

 

(Applicant Signature)

 

 

 

 

 

 

 

(Date)

 

 

 

OFFICE USE ONLY

 

 

 

Reason for Reissue:

 

 

 

 

 

 

 

 

 

 

 

Date

Processor ID

 

 

 

Product Type

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REAL ID

REGI

CLP

CYCI

SPRI

JUVI

MPDI

Wisconsin or Out-of-State License Number

 

State

Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

PROB RGLR OCCL SPRR JUVP NON

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hearing (CDL Only)

Examiner ID

 

 

Application Type

 

 

 

 

 

 

 

 

 

 

 

ORG RNW DUP REI RSM AMD COA

Skill Test Score

 

Highway Signs

 

Knowledge

Class(es) Issued

 

 

Endorsements

 

 

 

 

 

 

 

 

A B C

D M

 

H

N P S T F

 

 

 

 

 

 

 

 

Payment

 

 

 

 

Amount

 

 

 

 

 

 

 

 

Check Cash

CC Acct.

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Processor Signature)

 

 

 

 

 

(Processor ID)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VISION

 

 

 

 

 

 

 

 

Check if vision section completed by DMV Examiner

 

 

 

 

 

 

 

Temporal Field of

Being duly licensed to practice

Wisconsin, or Other

Visual Acuity

Without RX

 

With RX

 

 

Vision In Degrees

Optometry Medicine, in:

 

 

 

 

 

 

 

 

 

Name of State or Country

 

 

 

 

 

Right Eye

20/

 

 

20/

 

 

 

 

 

 

 

 

 

 

 

Left Eye

20/

 

 

20/

 

 

 

 

I certify that the findings are correct

 

 

 

 

 

 

 

 

 

and I examined this applicant on:

 

 

 

 

(Exam Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Corrective lenses required while driving

 

Color Perception

 

 

 

 

 

 

 

 

YES NO

 

 

 

Normal Deficient

 

 

 

 

 

 

 

 

Progressive eye disease or cataracts

If Yes, to Progressive eye disease or cataracts

 

X

 

 

 

 

 

 

YES NO

 

 

One Eye

Both Eyes

 

 

 

 

 

 

 

 

 

 

(Eye Examiner Signature)

 

 

 

 

(License #)

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