LOUISIANA DEPARTMENT OF PUBLIC SAFETY

Office of Motor Vehicles

38 Hour Commercial Driving School Application
Please attach $25 Money Order, Cashier’s Check or Business Check

 

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NAME OF DRIVING SCHOOL                                                                                                                           PHONE NUMBER

 

DRIVING SCHOOL MAILING ADDRESS

 

PHYSICAL CLASSROOM LOCATION

 

   

NAME OF OWNER                                                                                                  DATE OF BIRTH                            DRIVER’S LICENSE NUMBER

 

OWNER’S HOME ADDRESS

 

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CELL PHONE #                                                          FAX NUMBER                                                      E-MAIL ADDRESS

 

 

HAVE YOU EVER BEEN ARRESTED, DETAINED, CHARGED, INDICTED OR SUMMONED TO ANSWER AND APPEAR FOR ANY CRIMINAL OFFENSE, EXCLUDING MINOR TRAFFIC CITATIONS, IN THIS STATE OR ANY OTHER STATE?       YES                    NO   IF YES, LIST ALL REQUIRED INFORMATION BELOW.  YOU MUST INCLUDE CERTIFIED COPY OF COURT DISPOSITIONS ON ALL OFFENSES AND CONVICTIONS.  FAILURE TO INCLUDE ALL INFORMATION AND RECORDS WILL RESULT IN DELAY OR DENIAL OF YOUR APPLICATION.                                                         Offense/Conviction               Date of Offense/Conviction       City, State              Disposition (Attach certified copy of court disposition)       Fingerprints must be submitted for a background check.  See attached fingerprint instructional letter and forms.

 

List below the vehicles that are registered to the school as well as owner of the school:

Year	Make	Model	License Plate #	VIN #	Dual Controls?
					YES	NO

 

You must attach a Certificate of Insurance covering the above vehicles.  This certificate must list Office of Motor Vehicles, Attention: Debbie Hoover, P. O. Box 64886, Baton Rouge, LA  70896 as the certificate holder.

 

 

I hereby certify that the statements made in this application are true and correct.  I also hereby certify that I have received, read, understood and will adhere to all rules and regulations in accordance with La. Administrative Code, Title 55, Part III.

 

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Signature of Owner                                                                                                                                                              Date

 

  Sworn to and subscribed before me on this day of ,  20 .

 

Notary Public ________________________________________________________________________________________________