Free MV3027 Instructions and sample application - Wisconsin

OCCUPATIONAL OPERATOR LICENSE APPLICATION INSTRUCTIONS

MV3027 12/2007

Items needed to apply · · · · ·

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Complete a Wisconsin Operator License Application MV3001 and the attached Occupational Operator License Application MV3027. If you are under 18 years old, a sponsor signature is required. Complete necessary tests, including vision screening. Provide proof of your identity, such as an ID with your picture on it or a document with your signature. Provide an SR22 insurance certificate. If the Division of Motor Vehicles (DMV) does not show your license as revoked or suspended, provide a conviction status report or a photocopy of the front and back of a court completed citation. You may contact the DMV at 608-266-2261 to verify if this document is needed. Pay a $50 nonrefundable fee. Filing an application and paying a $50 fee does not guarantee issuance of an occupational license. If you have two or more OWI convictions and are revoked for OWI, prove you have completed an assessment and are participating in a driver safety plan. If the court ordered an Ignition Interlock Device (IID) be installed in any vehicle you operate (excluding motorcycles and commercial motor vehicles), provide an IID Installation form MV3598 from an approved IID installer. If you have been revoked as an habitual traffic offender (HTO), the circuit court in your county of residence must approve the issuance of your occupational license.

Instructions for completing the application for Occupational License. (PRINT CLEARLY) 1. Fill in your name, birth date, driver license number, and telephone number. 2. List your occupation(s) and the name(s) of your employer(s). Self employed person(s) provide business name(s). 3. Check the appropriate boxes for ALL the uses you need for the occupational license. If you are a student, indicate the school you are attending. Homemaker may include, but is not limited to: grocery shopping, medical appointments, caring for parent or spouse, taking children to school activities, child visitation, etc. Homemaker does NOT include operation for pleasure or recreation. An occupational license cannot be used for driving a commercial motor vehicle. If you have been convicted of Operating While Intoxicated (OWI), you must complete an alcohol assessment. You will also be required to complete a Driver Safety Plan. If you are currently enrolled in a Driver Safety Plan, check the yes box and include the time you will need to drive to attend your sessions. If you have completed or have not yet enrolled in a Driver Safety Plan, check the no box. 4. List the counties or states in which you need to drive. This list must include your county of residence. Be sure to consider ALL areas where you need to drive. For example, if you live in Madison and must travel to Green Bay for work, be sure to list ALL counties you will be driving through to get to Green Bay. You must be able to define the areas where you will be driving. A statement like Southern Wisconsin is unacceptable because the area cannot be specifically defined. 5. List your actual driving time only. This should include only the time you will be operating a vehicle. Be sure to give yourself enough time to go to and from your destination. You can legally drive only during the times you list. Do not list the hours you will be working unless you need to drive while you work. When listing the time you will be driving, indicate A for AM, P for PM, N for Noon and M for Midnight. Start and Stop times must end in either :00, :15, :30 or :45. For example, if it takes you 35 minutes to go to your place of employment and you start at 10:00 a.m., list your Start as 9:15 a.m. and your Stop as 10:00 a.m. Do NOT list hours starting on one day and ending on the next. Example: If you need to drive 10 p.m. - 2 a.m. on Saturday, list your hours as 10 p.m. - 12 midnight on Saturday and 12 midnight to 2 a.m. on Sunday. Do NOT exceed 12 hours for any one day and 60 hours for the entire week. 6. Total the amount of time you will be driving for each day and for the entire week. 7. Sign and date the application. By signing the application, you are certifying that you are operating a motor vehicle, during the times and at the locations specified in the application, as necessary for fulfilling the duties of your occupation. A sample of a completed application MV3027 is on the reverse side. For additional information see the Occupational License Information form MV3505 or visit the Wisconsin Department of Transportation web page (www.dot.wisconsin.gov). You may call DMV's automated telephone system at 608-261-0368 to see if you are eligible for an occupational license.

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MV3027

12/2007
First MI

APPLICATION FOR OCCUPATIONAL OPERATOR LICENSE
Last Birth Date - Month - Day - Year Driver License Number

Wisconsin Department of Transportation
Telephone (7:30 a.m - 5:00 p.m.)

(1) Applicant Name -

Julie
(2) Occupation Employer

M Hugo Gas

Citizen

mm-dd-yy

C 123-1111-1111-01
(3) Occupational License Uses - Check ALL Necessary

715-999-8888
Emergency Service Provider

Clerk Groomer

X X

Church Homemaker Student at:

Citizen K/9 Grooming (Self-employed)

Have you enrolled in a Driver Safety Plan?
(4) List all the Counties or States in which you will be driving - Be sure to include your County of Residence

Yes

X No

Ashland and Bayfield
(5)

If Yes, be sure to list below the hours you will need to drive to attend.

Actual Daily Driving Time - List only the hours you will actually be driving, beginning with the time you start driving and ending when you stop driving. You can legally drive only during the times listed. Do NOT exceed 12 hours for any one day and no more than 60 hours for an entire week. Indicate A for a.m. and P for p.m. Use 12 M for midnight & 12 N for noon. Start and Stop times must end in either :00, :15, :30 or :45. For example, if it takes you 35 minutes to go to your place of employment and you start at 10:00 a.m., list your Start as 9:15 a.m. and your Stop as 10:00 a.m. Do NOT list hours starting on one day and ending on the next. Example: If you need to drive 10 p.m. - 2 a.m. on Saturday, list your hours as 10 p.m. - 12 midnight on Saturday and 12 midnight to 2 a.m. on Sunday.

Monday
Start
A/P or M/N

Tuesday
A/P or M/N

Wednesday
A/P or M/N

Thursday
A/P or M/N

Friday
A/P or M/N

Saturday
A/P or M/N

Sunday
A/P or M/N

Stop

Start

A/P or M/N

9 :15 A 10 :00 A 3 :00 P
: : : : : :
(6)

3 :15 A

5 : 00 P 11 : 30 A 5 :00 P
: : : : : : : : : : : : :

Total Driving Time- Actual driving time cannot be more than 12 hours for any one day and no more than 60 hours for the entire week.
Monday Hours

2:45

Tuesday Hours

Applicant Certification - Operating a motor vehicle, at the times and at the locations specified in this application, is necessary for fulfilling the duties of my occupation described above.
(7) Applicant Signature

E L P M A S
Stop Start Stop Start Stop Start Stop Start

A/P or M/N

A/P or M/N

A/P or M/N

A/P or M/N

Stop

Start

A/P or M/N

Stop

A/P or M/N

3 :45 A

9 :00 A
: : : :

5 :00 P
: : : :

3 :15 A

3 :45 A

6 :00 A 12 :00 N

6 :00 A 11 :00 A 12 :00 M 2 :00 A 7 :30 A 10 :30 A
: : : : : : : : : : : :

11 : 30 A 5 :00 P
: : : :

6 :00 P 10 :00 P 11 :30 A 12 :30 P
: : : : : : :

2 :00 P

6 :00 P

:

:

:

10 : 00 P 12 :00 M
: : : : : : : :

: : : :

: : : :

: : : :

: : :

: : :

: : :

6

Wednesday Hours

8

Thursday Hours

6

Friday Hours

10

Saturday Hours

12

Sunday Hours
Total Hours Examiner ID

5 49:45

X

Julie M. Citizen
Court Signature

Date

mm-dd-yy
Court Signature Date

Circuit Court

Distribution: 2 - WDOT; 1 and 3 - Operator

Blank form MV3027