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Unformatted text preview: Parent or Guardian Signature Parent or Guardian Signature Acknowledged before me this date. Date Notary or MVD Agent Signature Notary or MVD Agent Signature Acknowledged before me this date. State Commission Expires Date County County State Commission Expires MVD USE Medical Observations Medical Certificate Expires Birth Certificate State/Control # Tribal CIB # State Driver License/ID Card # Citizenship/Immigration Type/Form # Issue Date Exp. Date Social Security # Credit Card Exp. Date Issuing Institution MVD Agent Additional Documents Visual Acuity Left Right 3rd 2nd 1st 20/ Blind MVD Agent Blind 20/ Both Visual Field Nasal-Right Left Right ° 20/ Nasal-Left ° ° MVD Agent Corrective Lens Date Rules of the Road Series Grade MVD Agent Date Date Series Grade MVD Agent Date Grade MVD Agent Date Grade MVD Agent Date Series Grade MVD Agent Date Grade MVD Agent Date Grade MVD Agent 3rd Points 1st 2nd Road/Skills Test Grade MVD Agent ° Actual Driving Test 10 ea Crowding center line Motorcycle Knowledge Grade MVD Agent Automatic Failure Codes Fails to make full stop 10 ea Date Offset Backing Other (describe below) A – Struck pylon E – Involved in accident F – Dangerous action 10 ea Following distance B – Distance from curb 10 ea Right of way to vehicle or pedestrian C – Jumped curb or took too long G – Serious violation 10 ea Over speed limit (within 5-10 mph) D – Inability after three attempts H – Refused instructions 4 ea Choice of proper lane 4 ea Signaling 4 ea Use of brakes 4 ea Observation and planning 2 ea Operation of motor vehicle 2 ea Position after stopping Validation 2 ea Waits too long 2 ea Too slow 2 ea Steering 2 ea Improper turn Total Points Off Immediate Rejection: I – Failed vehicle inspection Comments...
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This note was uploaded on 02/07/2014 for the course MIS 304 taught by Professor Mejias during the Spring '07 term at University of Arizona- Tucson.

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