Free MDOS Form - Michigan

AR-0018 (7/2006) By Authority of Public Act 300 of 1974 Michigan Department of State

DEPARTMENT USE ONLY

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APPLICATION FOR MOTOR VEHICLE SPECIALTY or MASTER MECHANIC CERTIFICATION
Please read instructions on back before completing. Please TYPE or PRINT 1. NAME 3. HOME ADDRESS (Last) (Street) (First) (City) (Middle)

CERTIFICATION NUMBER THIS FORM IS USED TO APPLY FOR ORIGINAL MECHANIC CERTIFICATION ONLY. APPROVED BY DATE

2. BIRTH DATE (County)

(Month) (State)

(Day)

(Year) (Zip)

4. HOME TELEPHONE NUMBER

5. DRIVER LICENSE OR ID NUMBER 8 or under 9 10 11 12 GED

6. SOCIAL SECURITY NUMBER College: 1 2 3 4

(

)

7. A. Circle the highest school grade completed:

B. Number of months of vehicle mechanic education or training you have received: C. Number of years you have been employed as a motor vehicle mechanic: D. States/jurisdictions where you are presently licensed or certified as a motor vehicle mechanic: 8. CHECK THE REPAIR CATEGORIES IN WHICH YOU HAVE PASSED TESTS AND ARE APPLYING FOR MECHANIC CERTIFICATION. Automobiles and Light Trucks (Vehicles under 10,000 #GVW) A. B. C. D. E. F. G. H. I. J. K. All Repairs B through I (Master Certification) Engine Repair Automatic Transmission Manual Transmission, Front and Rear Drive Axle Front End, Suspension and Steering Systems Brakes and Braking Systems Electrical Systems Heating and Air Conditioning Engine Tune-Up/Performance Pre-1973 Vehicles Unitized Body Structural Repair L. M. N. P. Q. R. S. T. U. V. Collision-Related Mechanical Repair Motorcycle Recreational Trailer All Truck Repairs Q through V (Master Certification) Engine Repair - Gasoline Engine Repair - Diesel Drive Train Brakes and Braking Systems Suspension and Steering Systems Electrical Systems

Heavy-Duty Trucks (Vehicles over 10,000 #GVW)

9. ARRESTS OR CONVICTIONS - Have you been arrested or convicted of a crime, other than a traffic violation, in Michigan or any other state within the past 10 years? NO YES If your answer is YES, give complete details of all arrests or convictions which took place in the past 10 years. Attach an additional sheet, if necessary.

Details:

Date of Arrest(s) or Conviction(s): Court(s): City and State:

10. FEE - A FEE OF $25.00 MUST ACCOMPANY THE APPLICATION FOR SPECIALTY OR MASTER MECHANIC CERTIFICATION. Enclose a check or money order made payable to STATE OF MICHIGAN. Applications without the correct fee will be returned. Mail application and fee to: MICHIGAN DEPARTMENT OF STATE BUREAU OF REGULATORY SERVICES LICENSING UNIT LANSING, MICHIGAN 48918-1210 11. CERTIFICATION AND SIGNATURE
I certify to the truth and accuracy of representations made in this application, including all statements attached hereto, and further agree that any legal process affecting me served on the Secretary of State or his/her deputies shall have the same effect as if personally served on me, and hereby authorize the release of all criminal history information that pertains to me on file at the Michigan State Police Central Records Division or at any court of record. Any misleading, incomplete, or false statement may be grounds for revocation, suspension, or denial of certification as a Michigan motor vehicle mechanic.

Don't forget to sign and date the form before mailing.
Signature DEPARTMENT USE ONLY Date

INSTRUCTIONS FOR COMPLETING APPLICATION PRINT OR TYPE ALL INFORMATION
Item 1......Enter your last, first, and middle names. Item 2......Enter your birth date. Item 3......Enter your home address. Item 4......Enter your home telephone number. Item 5......Enter your driver license or State of Michigan ID number. Item 6......Enter your Social Security Number. Item 7.......A. B. C. D. Circle the highest grade you completed in school. Enter the number of months of education or training you have received in motor vehicle service and repair while attending high school, trade or technical schools, or college. Enter the number of years that you have been employed as a motor vehicle mechanic for compensation. (NOTE: THERE IS NO MINIMUM EXPERIENCE REQUIREMENT FOR MICHIGAN CERTIFICATION.) If you are presently licensed or certified to work as a motor vehicle mechanic, please list the states or jurisdictions which issued your license or certification.

Item 8......Check the repair categories in which you have passed tests and are applying for mechanic certification. NOTE: If you are ASE certified, you must attach a copy of your test results or license. Item 9......You must indicate whether you have been arrested or convicted of a crime within the past 10 years. If so, you must provide complete details of each arrest and conviction. Item 10....THE FEE FOR SPECIALTY OR MASTER MOTOR VEHICLE MECHANIC CERTIFICATION IS $25.00. Make check or money order payable to STATE OF MICHIGAN. Applications without the $25.00 fee will be returned. Item 11....You must sign the application attesting to the best of your knowledge and belief that the information presented on the application form is true, correct, and complete, and authorizing the Department of State to obtain criminal history information from the Michigan State Police. AFTER YOU HAVE COMPLETED THE APPLICATION, ENCLOSE CHECK OR MONEY ORDER AND MAIL TO:

Michigan Department of State Bureau of Regulatory Services Licensing Unit Lansing, MI 48918
REMINDER: If you perform motor vehicle repairs part-time, evenings, or in addition to a full-time job as a mechanic at any place other than a registered repair facility, you must obtain a repair facility registration if you intend to be paid for your work. An application for facility registration may be obtained by telephoning 1-888-SOSMICH (1-888-767-6424) or by writing to the above address. You may also call this number if you have any questions about mechanic testing, certification, or trainee permits.