Form 5140 - Application For Military Commercial Driver License (Cdl) Skills Test Waiver

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Missouri Department of Revenue

Form

Application for Military Commercial

5140

Driver License (CDL) Skills Test Waiver

This form may be used by qualified active duty or retired military applicants. This waiver allows a qualified military applicant to apply for a Commercial Driver

License (CDL) without skills testing. CDL knowledge (written) test(s) are not waived and must be submitted to the license office along with this application.

Name (Last, First, and Middle)

Driver License Number

Residence Address (Street)

City State Zip Code County

Mailing Address (If Different)

City State Zip Code County

During the two years before today’s date:

• Have you had more than one license? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Has your license been suspended, revoked, cancelled, or disqualified in this or any other state? . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of causing a fatality through the negligent operation of a commercial motor vehicle? . . . . . . . . . . . .

Yes

• Have you been convicted of using any vehicle in the commission of a felony involving the manufacturing, distributing,

or dispensing of a controlled substance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of driving a commercial motor vehicle without a commercial license? . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of driving a commercial motor vehicle without a commercial license in your possession? . . . . . . . . .

Yes

• H ave you been convicted of driving a commercial motor vehicle without the proper class or endorsements? . . . . . . . . . . . . . .

Yes

• H ave you been convicted of driving a commercial motor vehicle while using a hand-held mobile phone? . . . . . . . . . . . . . . . . .

Yes

• H ave you been convicted of driving a commercial motor vehicle while texting? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of driving while intoxicated or driving while under the influence of alcohol (includes BAC)? . . . . . . .

Yes

• H ave you been convicted of driving while under a controlled substance or refusal to submit to an alcohol test? . . . . . . . . . . . .

Yes

• H ave you been convicted of leaving the scene of an accident? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of a felony involving a motor vehicle? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of speeding 15 or more MPH over the posted speed limit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of careless and imprudent driving? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of following too closely? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of improper lane change? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you been convicted of a violation in connection with a fatal accident? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• H ave you been convicted of any state law or county or municipal ordinance relating to the operation of any type

of motor vehicle in connection with an accident? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

• Have you had more than one conviction for any type of motor vehicle for serious traffic violations? . . . . . . . . . . . . . . . . . . . . . .

Yes

Have you been regularly employed in a job requiring operation of a commercial motor vehicle and have operated

the vehicle for at least sixty days during the two years immediately preceding this application for a commercial

driver license? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

Is the vehicle you have operated representative of the commercial motor vehicle you currently operate or expect to operate?

Yes

Select one that applies:

I have been honorably discharged from military service. I am providing proof of military service (a copy of Form DD214); a notarized statement

specifying the types of commercial vehicles I am qualified to operate completed by my former commanding officer on the reverse of this form;

and a copy of my military driving record.

I am an active duty member of the Armed Forces. I am providing a notarized statement specifying the types of commercial vehicles I am qualified to

operate completed by my commanding officer on the reverse of this form; and a copy of my military driving record.

Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.

Applicant’s Signature

Title