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STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
SPECIAL CERTIFICATE APPLICATION
CHP 295 (Rev. 1-21) OPI 061
APPLICANT FOR A SCHOOL BUS, SPAB, FLV, YOUTH BUS, GPPV, OR VDDP CERTIFICATE
(ACCIDENT INCIDENT DATA - ATTACH ADDITIONAL PAGE IF NEEDED).
RESTRICTIONS
ENDORSEMENT
CHP EMPLOYEE'S SIGNATURE
MAY DRIVE VEHICLE WITH TWO-SPEED REAR AXLE
MAY TRANSPORT FROM PLACE OF RESIDENCE (YOUTH BUS ONLY)
MEDICAL - MEDICAL EXAMINER'S CERTIFICATE, Section 12517.2 CVC
WRITTEN TEST - Section 12517.4 CVC
FIRST AID TEST - Section 12522 CVC (SCHOOL/YOUTH BUS ONLY)
DRIVE TEST - Section 12517.4 CVC
FINGERPRINTS - Section 12517.3(a)(1) CVC
FIRST AID CARD ISSUE DATE:
NONE
AUTOMATIC TRANSMISSION ONLY
HYDRAULIC BRAKES ONLY
TYPE 2 BUS ONLY
CONVENTIONAL OR TYPE 2 BUS ONLY
TWO-AXLE MOTOR TRUCK OR PASSENGER VEHICLE ONLY
FIRST AID TEST WAIVED
LICENSING ELIGIBILITY DOCUMENT (Permit or Temporary License)
TRAINING REQUIREMENTS VERIFICATION DATE:
DRIVER LICENSE AND CERTIFICATE - Sections 12517(a), 12519(a), 12523(a),
12523.5(a), 12523.6(a) CVC
TESTS RULES AND REGULATIONS FIRST AID
TEST
TEST
CERTIFICATE INFORMATION - CHP USE ONLY
1
2
3
1
2
3
DATE ANSWERS MISSED DATE ANSWERS MISSED
ISSUE DATE (SHOULD BE SAME AS ON THE DL-45) DATE FILE SENT FOR DMV REVIEW
DATE OF APPLICATION
DL-45 SC NUMBER AREA
DATE
Information on this form pertains to the issuance of a certificate to operate
a motor vehicle under Division 6 of the California Vehicle Code (CVC).
Failure to provide information or providing false information on this and/or
associated forms is cause for refusal, suspension, or revocation of the
certificate sought.
Except as made confidential by law or exempted under the Freedom of
Information Act, this information is a public record. It is regularly used by
law enforcement agencies, other state agencies, and insurance
companies, and it is open to inspection by the public. You are entitled to
inspect or obtain copies of information in your record during regular
office hours. By law, the information from this form is transferred to the
Department of Motor Vehicles (DMV), Commercial Driver License Unit,
P.O. Box 944278, Sacramento, CA 94290-0001, telephone (916) 657-5771,
and it is maintained as part of your driving record. This form and related
documents are maintained by the California Highway Patrol (CHP) office where
you applied and tested for the certificate, or the CHP office in the area where
you work.
Your Social Security Number is required to ensure positive identification for the
personal background check required by the CVC.
CERTIFICATE TYPE CERTIFICATE STATUS
Farm Labor
School Bus
VDDP
SPAB
Upgrade
Original
GPPV
Youth Bus Duplicate
Downgrade
Renewal
PLEASE PRINT CAREFULLY
DRIVER LICENSE INFORMATION
CHP USE ONLY
SEX
CORRECTIVE LENSES REQUIRED
F
YES NO
M
NAME (FIRST, MIDDLE, LAST)
SOCIAL SECURITY NUMBER HOME TELEPHONE NUMBER
HOME ADDRESS (NUMBER AND STREET)
CITY ZIP CODE
EMPLOYER WORK TELEPHONE NUMBER
EMPLOYER'S ADDRESS (NUMBER AND STREET)
CITY ZIP CODE
CHP OFFICE WHERE YOU LAST APPLIED FOR A CERTIFICATE
PLACE OF BIRTH (CITY AND STATE)
HAIR EYES HEIGHT WEIGHT
DATE OF BIRTH (MONTH, DAY, YEAR)
STATE NUMBER CLASS ENDORSEMENTS EXPIRES MEDICAL CARD EXPIRES
FBI
DATE SENT TO: DOJ
DATE RECEIVED FROM: DOJ
FBI
FINGERPRINTS
ATI#
RESTRICTIONS
MARK AN X IN THE APPROPRIATE PASS/FAIL BOX FOR EACH TEST TAKEN.
P F P F
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Please read each item carefully and sign at the bottom of the page in the
presence of CHP personnel.
APPLICANT REQUIREMENTS - ORIGINAL
1.
2.
3.
4.
5.
6.
APPLICANT REQUIREMENTS - RENEWAL
1.
2.
3.
4.
APPLICANT REQUIREMENTS - CERTIFICATE UPGRADE OR DOWNGRADE
1.
2.
3.
REQUIRED TESTS
1.
2.
3.
4.
MANDATORY DISQUALIFYING CRITERIA
DMV shall deny or revoke the certificate if the applicant:
1.
2.
3.
4.
5.
6.
A valid driver license.
Current medical examination report (DL-51) and medical examiner's certificate.
Driving history printout.
$32 for fingerprints plus $25 for the DL-45.
Licensing eligibility document (e.g., permit, temporary license).
The applicant will be fingerprinted by the CHP. The fingerprints will be sent to
the Department of Justice and, if applicable, to the Federal Bureau of
Investigation for a criminal background review.
A valid driver license.
Current medical examination report (DL-51) and medical examiner's certificate.
Documentation of required training.
$12 for the DL-45.
A valid driver license.
Current medical examiner's certificate.
$12 for DL-45.
An applicant must pass a written test on the laws and regulations governing
passenger transportation safety and safe driving practices. The test may be
taken prior to the return of the criminal background review. A written test is
not required for a VDDP certificate.
An applicant must pass a drive test using a vehicle comparable to those to be
driven by the applicant. The drive test includes a pre-trip inspection of all
gauges, instruments, and controls, with critical emphasis on brake systems
and their operation. The drive test shall not be taken prior to the return of the
criminal background review. Restrictions may be placed on the certificate
depending on the type of vehicle used during the drive test. A drive test is not
required for a VDDP certificate.
An applicant for a school or youth bus driver certificate must pass a written first
aid test. This test may be waived if the applicant possesses a current first aid
certificate issued by the American Red Cross or by an organization approved by
the Emergency Medical Services Authority, or possesses a current license as a
physician and surgeon, osteopathic physician and surgeon, or registered nurse,
or a current certificate as a physician's assistant or emergency medical
technician.
Tests for certificate upgrades may be required.
Has been convicted of a sex offense defined in Section 44010 of the
Education Code (EDC).
Has been convicted, within the preceding two years, of an offense involving
the use, possession, or sale of drugs.
Has been convicted, within the preceding three years, of hit and run, reckless
driving, or driving under the influence.
Has been convicted of a violent or serious crime per Sections 667.5(c) or
1192.5(c) of the Penal Code.
Fails to pass the written test(s) or drive test.
Within the preceding three years, has had driving privileges revoked or
suspended, or has been placed on probation for any reason
involving unsafe operation of a motor vehicle.
DISCRETIONARY DISQUALIFYING CRITERIA
DMV may deny, suspend, or revoke the certificate if the applicant:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
PHYSICAL QUALIFICATIONS
An applicant is physically qualified to drive a vehicle if the person:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
I hereby certify that I have read, or had read to me, and that I understand all of
the above.
Has committed any act involving moral turpitude, regardless of when the act
was committed.
Has been the cause of three crashes within the last 12
months.
Has been the cause of a crash resulting in a fatality, serious injury, or $1,000
damage within the preceding 24 months.
Has violated any law, rule, or regulation for the safe operation of a vehicle
for which the certificate was issued.
Has violated any restriction of the certificate.
Has made a false statement on the application.
Is a negligent or incompetent operator.
Habitually uses or is addicted to alcohol or drugs.
Does not meet minimum medical standards.
Has been convicted of specific crimes within the past seven years.
Has been convicted of an offense, other than a sex offense, that is punishable
as a felony within the past seven years.
Has been dismissed for a cause related to pupil transportation safety.
Has been convicted, within the preceding seven years, of any offense related to
the use, sale, possession, or transportation of drugs.
Has been arrested for or charged with any sex offense, as defined in Section
44010 EDC.
Violates Section 5387(b) of the Public Utilities Code (driving a bus without a
current/valid driver license of the proper class, a passenger vehicle
endorsement, or the required certificate).
Has been reported to have left a pupil unattended on a school bus pursuant to
Section 39843 EDC.
Has no loss of a foot, a leg, a hand, or an arm, or has been granted a waiver
pursuant to Section 391.49 of the Federal Motor Carrier Safety Regulations
(FMCSR).
Has no impairment of a hand or finger which interferes with prehension or
power grasping; or, an arm, foot, or leg which interferes with the ability to
perform normal tasks associated with operating a motor vehicle; or any other
significant limb defect or limitation which interferes with the ability to perform
normal tasks associated with operating a motor vehicle; or has been granted a
waiver pursuant to Section 391.49 FMCSR.
Has no myocardial infarction, angina pectoris, coronary insufficiency,
thrombosis, or any other cardiovascular disease of a variety known to be
accompanied by syncope, dyspnea, collapse, or congestive cardiac failure.
Has no respiratory dysfunction likely to interfere with the ability to control and
drive a motor vehicle safely.
Has blood pressure in accordance with Section 391.43(f) FMCSR.
Has no established medical history or clinical diagnosis of rheumatic, arthritic,
orthopedic, muscular, neuromuscular, or vascular disease which interferes with
the ability to control and operate a motor vehicle safely.
Has no established medical history or clinical diagnosis of epilepsy or loss of
consciousness.
Has no mental, nervous, organic, or functional disease or psychiatric disorder
likely to interfere with the ability to drive a motor vehicle safely.
Has distant visual acuity of at least 20/40 (Snellen) in each eye with or without
corrective lenses and at least 70 degrees in the horizontal meridian in each eye,
and the ability to recognize the colors red, green, and amber.
First perceives a forced whispered voice at not less than 5 feet in the better ear
with or without the use of a hearing aid.
Does not use an amphetamine, narcotic, or any habit-forming drug.
Has no current clinical diagnosis of alcoholism.
Applicant's Signature
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Have you served in the military within the past seven years?
If yes, please explain your service.
CONVICTIONS
Please answer the following questions truthfully. Failure to answer any question truthfully may be cause for denial of your application. The
questions cover your lifetime, unless otherwise specified. Use additional paper for explanations, if needed.
YES NO
Have you ever been convicted of a crime?
If yes, please explain the conviction (e.g., spousal abuse, prostitution).
Have you ever gone by or used any other name?
If yes, please write the other name(s).
Have you ever been issued a driver license by another state?
If yes, indicate the state and driver license number.
YES NO
YES NO
YES NO
RESIDENCY HISTORY
Applicants for a California Special Driver Certificate must be fingerprinted for a background investigation conducted by the Department of
Justice, and by the Federal Bureau of Investigation for applicants who have not resided in California for the last seven consecutive years.
Please write the dates and locations of residence during the last seven years, starting with the most recent. Use additional paper, if needed.
Dates
Location
From
To (city and state)
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Dates of employment (Month/Year)
WORK HISTORY
Please indicate your employers for the past seven years, starting with the most recent. Use additional paper, if needed.
To be signed in the presence of a CHP School Bus Officer or Coordinator.
I hereby certify, under penalty of perjury, that all statements on this application are true. (Perjury is punishable by imprisonment, fine, or both.)
Dates of employment (Month/Year)
APPLICANT'S SIGNATURE
SCHOOL BUS OFFICER'S/COORDINATOR'S COMMENTS
Dates of employment (Month/Year)
Dates of employment (Month/Year)
EMPLOYER
TELEPHONE NUMBER
SUPERVISOR
ADDRESS
FROM
TO
EMPLOYER
TELEPHONE NUMBER
SUPERVISOR
ADDRESS
FROM
TO
EMPLOYER
TELEPHONE NUMBER
SUPERVISOR
ADDRESS
FROM
TO
EMPLOYER
TELEPHONE NUMBER
SUPERVISOR
ADDRESS
DATE
FROM
TO
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