First:

Last:  

Client Id#

Client Id Exp. Date

Month January February March April May June July August September October November December    Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991

DOB:

Month January February March April May June July August September October November December    Year 1945 1991

5hr#(Pre-licensing)

5hr. Issue Date

Month January February March April May June July August September October November December    Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991

   l

What area do you want your rt scheduled for?

Brooklyn Queens Staten Island Long Island Westchester  

*You must bring your picture permit and your pre-licensing certificate on the day of your road test.

If you are under 18 please answer the following questions...

Blue card?

Do you have a 20 hour certificate?