Fillable CERTIFICATE OF EMPLOYMENT (Department of Motor Vehicles )

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CERTIFICATE OF EMPLOYMENT (Department of Motor Vehicles )

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  • 18 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

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OBL236 (5/2013)
OCCUPATIONAL & BUSINESS LICENSING
555 WRIGHT WAY
CARSON CITY, NV 89711-0100
(775) 684-4690
www.dmvnv.com
CERTIFICATE OF EMPLOYMENT
SALESPERSON INSPECTOR FEES
Class: One Two Diesel Registration Renewal New $
Renewal $
DRIVE SCHOOL INSTRUCTOR: Behind the Wheel Transfer $
CDL Non CDL General Classroom
DUI SCHOOL INSTRUCTOR General Classroom Under 18
TRAFFIC SAFETY SCHOOL INSTRUCTOR Trainee
EMPLOYEE:
Full Legal Name DMV Occupational License #
NV Driver’s License # or Date of Birth Telephone Number ( ) -
Mailing Address
Street City State Zip
Physical Address
Street City State Zip
Nevada Revised Statute and Nevada Administrative Code Chapters:
I understand it is my responsibility to review the aforementioned Nevada Revised Statute and Nevada Administrative
Code Chapters with respect to the license or registration I am applying for and agree to comply with the requirements
stated therein. I declare under penalty of perjury that the information contained in this form is true and correct.
Employee’s Signature Date
EMPLOYER:
Business Name DMV Business License #
Address ( ) -
Street City State Zip Telephone Number
Authorized Representative’s Name and Title (Print)
Authorized Representative’s Signature
NRS/NAC Chapters
445B & 482
NRS/NAC Chapters 482 &
490
NRS/NAC Chapter
483
NRS/NAC Chapters 487 & 597
(Body Shop & Garage only)
Station and Inspector
licensing.
Broker, Dealer, Distributor,
Long Term Lessor,
Manufacturer, Rebuilder,
Salesman, Short Term
Lessor and Transporter
licensing, including Off-
Highway Vehicle Industry
Licensing.
Instructor and School
licensing.
Body Shop, Garage, Salvage
Pool and Wrecker licensing or
registration.
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CERTIFICATE OF EMPLOYMENT (Department of Motor Vehicles )

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Completed 24 December 2020

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