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Application For A Hazardous Materials Endorsement

Application FOR A Hazardous Materials ENDORSEMENTPLEASE PRINT CLEARLY The federal Transportation Security Administration requires all drivers who are applying for a Hazardous Materials Endorsement to complete and sign this form. Be sure to provide all information requested on pages 1 and 2. Mail the completed Application and a copy of your legal status document(s) to HazMat Unit, NYS DMV, 6 Empire State Plaza, Albany, NY 12228. I am applying for a : Combination HazMat & Tanker HazMat M F X LAST NAME FIRST NAME MIDDLE NAME SUFFIX PREVIOUS NAME USED (if any): LAST NAME FIRST NAME MIDDLE NAME COUNTRY OF CITIZENSHIP ALIEN REGISTRATION NO.

APPLICATION FOR A HAZARDOUS MATERIALS ENDORSEMENT PLEASE PRINT CLEARLY The federal Transportation Security Administration requires all drivers who are applying for a hazardous materials endorsement to complete and sign this form. Be sure to provide all information requested on pages 1 and 2.

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