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Application for Driving School Instructor Certificate

OOriginal Instructor s Certificate ($10) oInstructor s Certificate Renewal (see reverse) oAdditional Certificate (no fee) oClassroom Endorsement (no fee) oChange of Vehicle Class Endorsement (no fee) oDuplicate Instructor Certificate (no fee) Please allow 6-8 weeks for List any other name you have been known List any DMV related charges or court proceedings you are presently involved with (including Driving School , Private Service Bureau, PIRP, and/or Vehicle Safety) 1. Have you had one year or more of experience as a Driving School Instructor ? .. o o If yes, list the Driving School (s) you worked for and how many hours of instruction you provided for FOR Driving School Instructor Certificate (Please fill out Application completely and print clearly - this will reduce processing delays.)

5. My instructor certificate will immediately become void if my driver license is suspended or revoked, and that I will surrender my certificate to the driving school. 6. If I lose my certificate, I will have my employer submit a written request for a duplicate to DMV. This application must. be signed by an authorized official of the driving ...

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  Request, Instructor, Surrender

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