The action of the Director in refusing to issue a renewal, or suspending or revoking a license or instructor's certificate, may be appealed to the Superior Court in the county wherein such licensed school is located or licensed instructor(s) resides.
FOR DMV USE ONLY:______________
ISSUE DATE:______________
LIC. #:______________
STATE OF DELAWARE
DEPARTMENT OF PUBLIC SAFETY
DIVISION OF MOTOR VEHICLES
Application for Commercial Driver Training School License
(Please Type or Print)
Date:_____________________________________________________________
Name of School:____________________________________________________
Office Address:_____________________________________________________
_____________________________________________________
Office Telephone #: _______________________________
Owner's Name: Owner's Address: _____________________________________
Owner's Telephone #: Location of Classroom(s): _________________________
_________________________
Type of Business (circle one):
Sole Proprietor Partnership Corporation Association
List the name, title, and address of all Owners, Partners, Members and Officers:
Name Title Address
Please answer the following questions in full:
explain
Yes or No
House trailer; Residence; Temporary address; Room or rooms in a hotel or motel;
Rooming house; Garage: Single or multiple dwelling unit?
Yes or No
______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Yes or No
Yes or No
Training School meet the requirements of Section 7 of the Rules and Regulations
Governing the Licensing of Commercial Driver Training Schools and Instructors?
Yes ~ or No
Charts
Textbooks
Diagrams
Reference Books
Audio Driver Training Films
Audio Driver Training Slides
Testing Aids
Please list any additional training items:
Schedule of Fees
Course of Instruction Amount Terms (weekly/monthly)
With use of school vehicle
for driver training only
With use of school vehicle
for driver training law test
With use of school vehicle
for road test only
With use of students car
for driver training only
With use of students car
for road test only
With use of students car for
driver training and road test
Instructor to accompany student to road test in students car
Classroom training only
Other
Please list all persons authorized to sign contracts:
Name and address Title or Position
________________________________________________________________
Please list all persons licensed by the state of Delaware who are employed or associated with this Commercial Driver Training School or have filed for an instructor's license with the State of Delaware:
Name Driver's License Number
________________________________________________________________________________________________________________________________________________________________________
Conditions
As a condition for the issuance and the continued effect of a Commercial Driver Training School License, the undersigned undertake and agree to all of the following conditions:
I, the undersigned, certify that I have read the laws, rules, and regulations governing Commercial Driver Training Schools and that I agree to abide by the rules, regulations and laws set forth and further affirm that all statements made by me in this application are true and correct to the best of my knowledge.
Each owner, partner, or officer of the Commercial Driver Training School must sign in the space provided below in the presence of a Notary.
Signature Title
Signature Title
Signature Title
Signature Title
Sworn to and Subscribed before me this day of 19
___________________________________
Notary
********************************************************************************************
To knowingly make a false statement or conceal a material fact in this application shall result in the revocation of your Commercial Driver Training School License.
The licensee shall file with the Director of the Division of Motor Vehicles evidence of insurance with a company authorized to do business in the state, in the amount of at least $25,000 because of bodily injury to, or death of any one person in any one accident and, subject to said limit for one person; to a limit of $50,000 because of bodily injury to, or death of two or more persons in any one accident; and to a limit of $10,000 because of injury to or destruction of property of others in one accident.
Evidence of such insurance coverage must be in the form of a letter or certificate from the insurance carrier, which shall stipulate that the Director of the Division of Motor Vehicles shall be notified 10 (ten) days prior to the policy expiration or cancellation. Such notice of expiration or cancellation shall be mailed to the Director of the Division of Motor Vehicles, P. O. Box 698, Dover, DE 19903.
As required by law, a licensing fee in the amount of $115.00 (non-refundable) must accompany this application. * All original applications also require an investigation fee of $50.00 to defray the cost of clerical work, investigations, and like activities for the enforcement of the Rules and Regulations Governing the Licensing of Commercial Driver Training Schools and Instructors.
Please forward the completed application, including sample copies of contracts and schedule of fees, along with a check or money order made payable to the Division of Motor Vehicles to:
Division of Motor Vehicles
Attention: Commercial Driver Training
P. O. Box 698
Dover, DE 19903
********************************************************************************************
FOR DMV USE ONLY:
® Approved ® Disapproved
Reason:
By: Date:
Director of Motor Vehicles
EXPIRATION DATE INSTRUCTOR NO.___________
STATE OF DELAWARE
DEPARTMENT OF PUBLIC SAFETY
DIVISION OF MOTOR VEHICLES
Application for LICENSE COMMERCIAL DRIVER TRAINING INSTRUCTOR
(Please Print or Type)
Pursuant to Chapter 83, of the Delaware Motor Vehicle Laws, the undersigned does hereby apply for a license as Instructor for ____________________Driving School.
NAME
LAST FIRST MIDDLE
HEIGHT FT. INS. LBS.
COLOR HAIR COLOR EYES
HOME ADDRESS
Street city State Zip
Telephone No.
SCHOOL ADDRESS
Street City State Zip
Telephone No.
PLACE OF BIRTH DATE OF BIRTH
DRIVER LICENSE NO. STATE EXPIRATION
Have you ever previously been a licensed driver training instructor in Delaware
List names and addresses of all Driver Training schools at which you have been employed.
Type of Name Attended Year Degree
School Address From To Graduated or
Mo. Yr. Mo. Yr. Diploma Year Recd.
High
School
College or
University
If you did not graduate, what is the highest grade completed?
Have you passed High School
Equivalency Test? Yes No
Have you completed a Course
in Driver Education? Yes No
List employment for last 5 years---most recent employment
first---also include current.
Name of Firm______________________________________________
Address__________________________________________________
Dates employed from____________ To____________
Name of Firm ______________________________________________
Address__________________________________________________
Dates employed from ____________ To____________
Name of Firm ______________________________________________
Address__________________________________________________
Dates employed from ____________ To____________
Name of firm______________________________________________
Address__________________________________________________
Dates employed from ____________ To____________
Name of firm______________________________________________
Address__________________________________________________
Dates employed from ____________ To____________
ANSWER THE FOLLOWING WITH "YES" OR " NO"
(If answer is Yes, explain fully on another sheet.)
"No" Answers may be explained in this space.
Attach Recent
Photo Date photo was taken. A $50.00
fee for either original or
renewal, required by law, must
accompany this application,
to be forwarded to the
Division of Motor Vehicles,
P.0. Box 698, Dover, DE 19901.
Right
Index Finger
The applicant agrees that:
Sign Full Name _______________________________ Date _____________
This application must be signed by an authorized official of the Drivers Training School.
Official's Signature _______________________________Date__________
Subscribed and sworn to before me this day of 19
Notary Public ______________________________________
Notary's Address______________________________________
This application: Approved______________________________________
Disapproved By ______________________________________
Director of Motor Vehicle:______________________________________
Date______________________________________
Reason Disapproved:______________________________________
2 Del. Admin. Code § 2218-12.0