CERTIFICATION
I certify and affirm that I am a resident of Virginia, that all information presented in this application is true and correct, that any documents I have presented
to DMV are genuine, and that my appearance, for purpose of my DMV photograph, is a true and accurate representation of how I generally appear in public.
I make this certification and affirmation under penalty of perjury and understand that knowingly making a false statement on this application is a criminal
violation. By signing this form, I authorize DMV to verify the information provided on this application, as required to determine eligibility.
DATE (mm/dd/yyyy)
APPLICANT SIGNATURE APPLICANT NAME (print)
SELECTIVE SERVICE
All males under the age of 26 are required to check one of the following. Failure to provide a response will result in denial of your application.
By signing this application, I consent to be registered with Selective Service, if required by federal law.
I am already registered with Selective Service.
I am a non-immigrant alien in the U.S. and not required to register.
I authorize DMV to forward to the Selective Service System personal information necessary to register me with Selective Service.
GOVERNMENT EMPLOYEES - (Fee waiver certification)
I certify that I am employed by the:
to operate a motorcycle or commercial motor vehicle solely in the course of this employment and, because of such employment, I am entitled to the waiver
of the motorcycle class and/or commercial motor vehicle endorsement fee, provided I have paid for and hold a valid Virginia driver's license or have made
application for such.
Town ofCounty ofCity of Commonwealth of Virginia or
Have you been issued any license or ID Card in Virginia or another jurisdiction within the past 10 years?
If yes, identify any jurisdiction(s) in which you held a license or ID Card. Use the Supplemental Driver's Licensing History Sheet, form DL 2PA if additional
space is needed.
(Check the box for
the qualification
category that
applies)
INTERSTATE DRIVER INTRASTATE DRIVER (K restriction)
NON-EXCEPTED - I meet the qualification requirements
under 49 CFR Part 391 of the Federal Motor Carrier Safety
Regulations. (Medical examiner's certificate required)
NON-EXCEPTED - I meet the qualification requirements
under Title 19 § 30-20-80 of the VA Administrative Code.
(Medical examiner's certificate required)
EXCEPTED - I am exempt from the qualification
requirements under 49 CFR Part 391 of the Federal Motor
Carrier Safety Regulations. (No medical examiner's
certificate required)
EXCEPTED - I am exempt from the qualification
requirements under Title 19 § 30-20-80 of the VA
Administrative Code. (No medical examiner's certificate or
state-approved letter required)
JURISDICTION
LICENSE NUMBER
ISSUE DATE (mm/dd/yyyy)
EXPIRATION DATE (mm/dd/yyyy)
JURISDICTION
LICENSE NUMBER
ISSUE DATE (mm/dd/yyyy)
EXPIRATION DATE (mm/dd/yyyy)
JURISDICTION
LICENSE NUMBER
ISSUE DATE (mm/dd/yyyy)
EXPIRATION DATE (mm/dd/yyyy)
JURISDICTION
LICENSE NUMBER
ISSUE DATE (mm/dd/yyyy)
EXPIRATION DATE (mm/dd/yyyy)
PLACE OF DOMICILE - Your place of domicile may or may not be the same as your place of residence. Your place of residence is where you currently live
and your place of domicile is where your true, fixed and permanent home and principal residence is and to which you intend to return whenever you are
absent. My place of domicile is:
Virginia
Another U.S. state/territory or Canada/Mexico (not eligible - must apply
in place of domicile)
Outside of Virginia/Active Duty U.S. Military
(Active Duty Common Access Card (CAC) Required)
A country other than the U.S. (unexpired EAD or foreign passport and
I-94 required for a non-domiciled CLP/CDL)
Yes No
A - Combination vehicle with GVWR or GCWR of 26,001 lbs. or more
B - Single vehicle with GVWR of 26,001 lbs. or more, or towing a
vehicle less than 10,000 lbs. GVWR.
I want to be licensed to operate the type of vehicle(s) checked below:
C - Any vehicle that does not fit the definition of a Class A or Class B
vehicle and is either used to transport hazardous materials or
designed to carry 16 or more passengers, including the driver.
VEHICLE OPERATION AND ADDITIONAL APPLICANT INFORMATION
DL 2P (07/01/2020)
Va. Code §§46.2-323 and 46.2-342 require that you provide DMV with the information on this form (including your social security number). Your personally
identifiable information is being collected for record keeping purposes and will be disseminated only in accordance with Va. Code §§46.2-208, 46.2-209, and
the Driver’s Privacy Protection Act, 18 USC §2721. Persons convicted of certain sexual offenses (as listed in Va. Code §9.1-902) must register or re-register
with the Virginia Department of State Police as provided in Va. Code §§9.1-901, 9.1-903, and 9.1-904. If you provide a non-Virginia residence/home
address or non-Virginia mailing address, your application for a driver’s license or permit may be denied. Upon issuance of a driver’s license, commercial
driver's license or ID card in the Commonwealth of Virginia, any driver’s license, commercial driver's license or ID card previously issued by another state
must be surrendered and will be cancelled by the issuing state.
NOTICE
VETERAN INDICATOR
I would like to add/keep the veteran indicator on my commercial driver's license.
I would NOT like to add/keep the veteran indicator on my commercial driver's license.
You must complete a Virginia Veteran Military Service Certification (DL 11) form and provide an acceptable veteran service proof document to add the
veteran indicator, unless you have already done so.
BRAKES Full Air Brakes No Air Brakes (L restriction) Air Over Hydraulic Brakes (Z restriction)
TRANSMISSION Automatic Only (E restriction) Manual (includes automatic)
