APPLICATION FOR A LEARNER PERMIT STATE OF...
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APPLICATION FOR A LEARNER PERMIT B-307 REV. 1-2010 STATE OF CONNECTICUT DEPARTMENT OF MOTOR VEHICLES On The Web at ct.gov/dmv INSTRUCTIONS: Complete 1-13, then present items listed below to Cashier: 1. Identification (See reverse side of this form) 2. Resident Address Verification 3. Certificate of Parental Consent Form 2D (if not accompanied by authorized individual) 4. Test Fee, Learner Permit Fee 1. APPLICANT'S NAME (Last, First, Middle) VISION SCREENING RESULTS CERTIFICATION BY INSPECTOR/ AGENT KNOWLEDGE TEST CERTIFICATION BY APPLICANT PARENTAL CONSENT PROOF OF IDENTIFICATION 2. SEX 3. DATE OF BIRTH 4. HEIGHT 5. EYE COLOR M F 8. 6. MAILING ADDRESS (No., Street, City or Town, State, Zip Code) ft. in. 7. RESIDENCE ADDRESS (If different) 10. LIST ANY OTHER NAMES EVER USED (Alias, Maiden, etc.) 11. SOCIAL SECURITY NUMBER MEDICAL CERTIFICATION QUESTIONS YES NO DO NOT WRITE BELOW THIS LINE - OFFICE USE ONLY I hereby certify that I do not have any health or vision problems or conditions that prevent me from driving safely. Is your privilege to operate a motor vehicle suspended or subject to suspension in Connecticut or in any other state? SUSPENSION OCCURRED IN WHAT STATE? REASON FOR SUSPENSION IF YES, IN WHAT YEAR(S)? LICENSE OR ID CARD NO. (9 digits) TYPE OF ACCEPTABLE I.D. SHOWN I hereby request that a learner's permit and/or license be issued to the minor (age 16-17) filing this application. RELATIONSHIP TO MINOR SIGNED (Authorized Consenter) CONSENTER'S LIC. NO. OR OTHER I.D. X BRANCH OFFICE DATE SIGNED SIGNATURE OF APPLICANT X DATE SIGNED VISUAL AID USED NONE GLASSES/CONTACTS PASS FAIL RESULTS TYPE OF TEST TEST NUMBER COMPUTER WRITTEN ORAL TEST RESULT PASSED FAILED SIGNED (Inspector/Agent) X I hereby certify that the applicant has signed this application in my presence, and that I have examined the applicant and the results stated herein are true and correct. Learner's Permit With Corrective Lenses (B-restriction) US CITIZEN? 9. CONNECTICUT RESIDENT? YES NO YES NO 8a. If "NO", list ALIEN REGISTRATION NO. 13. The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty of false statement, in accordance with the provisions of Section 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I make a statement which I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution under the above-cited laws. Do you now, or have you ever previously held a Connecticut license, CT Non-driver Identification card or a license or ID Card issued by another state? 12. ID SCANNED EXAMINER INITIALS STAMP NO.
Transcript of APPLICATION FOR A LEARNER PERMIT STATE OF...
APPLICATION FOR A LEARNER PERMITB-307 REV. 1-2010
STATE OF CONNECTICUTDEPARTMENT OF MOTOR VEHICLES
On The Web at ct.gov/dmvINSTRUCTIONS: Complete 1-13, then present items listed below to Cashier:1. Identification (See reverse side of this form)2. Resident Address Verification3. Certificate of Parental Consent Form 2D (if not accompanied by authorized individual)4. Test Fee, Learner Permit Fee
1. APPLICANT'S NAME (Last, First, Middle)
VISIONSCREENING
RESULTS
CERTIFICATIONBY INSPECTOR/
AGENT
KNOWLEDGETEST
CERTIFICATIONBY APPLICANT
PARENTALCONSENT
PROOF OFIDENTIFICATION
2. SEX 3. DATE OF BIRTH 4. HEIGHT 5. EYE COLOR
M F
8.
6. MAILING ADDRESS (No., Street, City or Town, State, Zip Code)
ft. in.7. RESIDENCE ADDRESS (If different)
10. LIST ANY OTHER NAMES EVER USED (Alias, Maiden, etc.) 11. SOCIAL SECURITY NUMBER
MEDICALCERTIFICATION
QUESTIONS YES NO
DO NOT WRITE BELOW THIS LINE - OFFICE USE ONLY
I hereby certify that I do not have any health or vision problems or conditions that prevent me from driving safely.
Is your privilege to operate a motor vehicle suspended or subjectto suspension in Connecticut or in any other state?
SUSPENSION OCCURRED IN WHAT STATE? REASON FOR SUSPENSION
IF YES, IN WHAT YEAR(S)? LICENSE OR ID CARD NO. (9 digits)
TYPE OF ACCEPTABLE I.D. SHOWN
I hereby request that a learner's permitand/or license be issued to the minor (age16-17) filing this application.
RELATIONSHIP TO MINOR SIGNED (Authorized Consenter) CONSENTER'S LIC. NO. OR OTHER I.D.
X
BRANCH OFFICE
DATE SIGNED
SIGNATURE OF APPLICANT
X
DATE SIGNED
VISUAL AID USED
NONE GLASSES/CONTACTS PASS FAIL
RESULTS
TYPE OF TEST TEST NUMBER
COMPUTER WRITTEN ORALTEST RESULT
PASSED FAILED
SIGNED (Inspector/Agent)
XI hereby certify that the applicant has signed this application in mypresence, and that I have examined the applicant and the results statedherein are true and correct.
Learner's Permit With Corrective Lenses (B-restriction)
US CITIZEN? 9. CONNECTICUT RESIDENT?YES NO YES NO
8a. If "NO", list ALIEN REGISTRATION NO.
13.
The information provided to the Commissioner of Motor Vehicles herein is subscribed byme, the undersigned, under penalty of false statement, in accordance with the provisions ofSection 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if Imake a statement which I do not believe to be true, with the intent to mislead theCommissioner, I will be subject to prosecution under the above-cited laws.
Do you now, or have you ever previously held a Connecticut license,CT Non-driver Identification card or a license or ID Card issued byanother state?
12.
ID SCANNED
EXAMINER INITIALS
EXAMINER INITIALS
EXAMINER INITIALS
EXAMINER INITIALS
EXAMINER INITIALS STAMP NO.
WHAT YOU NEED TO KNOW ABOUT LEARNER PERMITS
Obtaining a Permit: If you are 16 - 17 years old, you need to obtain a learner permit before you can practice driving for your license. To obtain a permit:
Complete this formProvide identification documents. Please check DMV website at ct.gov/dmv for complete list orrefer to form B-313.Provide CT resident address verification (e.g., postmarked letter, certified school records)Bring your parent/legal guardian with you to DMV to sign the consent formPay the test and permit feesPass the knowledge test based on information in the Driver's ManualPass security checksPass the vision test
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Learning to Drive. Please see the DMV website at ct.gov/dmv or the CT Drivers manual for a complete listing of training requirements.
Home Training: Qualified trainer must be parent/legal guardian or other qualified person, over 20 years of age with valid driver license without asuspension for four (4) consecutive years. Parent/legal guardian must attend 2 hour parent training with a 16-17 year old permit holder at acommercial/secondary driving school.
Getting a License: If you complete a full driver education course through a commercial/secondary driving school you must hold the permit for 12-0 days(4 months); If you are home train and obtain your 8 hour driving safety class through a commercial/secondary driving school you must hold the permit for180 days (6 months). You must present the following documents to obtain your license:
Learner PermitCompleted CS-1 CertificationValid Registration and Inspection card for test vehicle16/17 year old applicants who have passed the road test must pass a Teen Final Exam
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GRADUATED LICENSE RESTRICTIONS
Learner Permit No passengers other than an instructor, qualified trainer. When receiving commercial or secondary driver education, other studentsmay be passengers.
Driver's License Until you reach 18, or for the first six months after you receive your license, you may not drive with passengers in the car except foryour parent/guardian; for the second six months you may not have any other passengers except for immediate family members.
Check the DMV website at ct.gov/dmv for details and exceptions.
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