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Driving License Application Form

Gathers the personal, medical, and prior-license details needed to process a driving license application.

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Applying for

New license Renewal Replacement

Purpose for application

Personal use Commercial use Learner's permit

Driver ID

Name

First Name

Last Name

Address

Street Address

City

State / Province

ZIP / Postal Code

Phone number

Date of birth

Are you older than 18?

Yes No

Place of birth

Gender

Male Female Other

Do you currently hold a license issued by another country?

Yes No

Issuing country

Driving license no.

Did you obtain your current foreign license by exchanging a license from another country?

Yes No

Issuing country of original license

Driving license no. of original license

Categories to be applied for

Category A (motorcycle) Category B (car) Category C (truck)

Has your driving license, learning permit, or driving privilege ever been suspended, revoked, cancelled, or denied?

Yes No

If 'yes', has your license, permit, or privilege since been restored, or has your application since been approved?

Yes No

Have you received, do you currently receive treatment, or take medication for any condition causing unconsciousness or unawareness (for example, epilepsy, fainting, or dizziness)?

Yes No

If 'yes', please specify

Do you need to wear glasses or lenses to drive?

Yes No

Do you need a hearing aid to drive?

Yes No

Have you lost the use of a leg, arm, hand, or eye?

Yes No

Organ/tissue donation

Yes, I want to be a donor

Parent/guardian consent (if applicant is a minor)

Parent/guardian name

First Name

Last Name

Date

Signature

Sign here

Applicant certification

Date

Signature

Sign here

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