Minnesota CDL Medical Self-Certification Form
This form is for all commercial driver's license (CDL) holders in Minnesota. It includes instructions for completing and submitting the self-certification form and medical examiner's certificate. It also contains a Tennessen Warning as required by state law.
Edit, Download, and Sign the Minnesota CDL Medical Self-Certification Form
Form
eSign
Add Annotation
Share Form
How do I fill this out?
Filling out this form ensures compliance with Minnesota's CDL requirements. Follow the instructions carefully to complete each section. Submit the form as specified to avoid any delays.
How to fill out the Minnesota CDL Medical Self-Certification Form?
1
Print the form.
2
Complete the driver information section.
3
Choose the applicable self-certification category.
4
Answer the medical certificate and waiver questions.
5
Sign and date the form.
Who needs the Minnesota CDL Medical Self-Certification Form?
1
All Minnesota CDL holders for initial certification.
2
CDL holders who are renewing their license.
3
CDL holders changing their license class.
4
CDL holders with a school bus endorsement.
5
CDL holders with a change in medical or interstate/intrastate status.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the Minnesota CDL Medical Self-Certification Form along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.
Edit your Minnesota CDL Medical Self-Certification Form online.
You can easily edit this PDF on PrintFriendly. Simply upload the document and use our robust editing tools to fill in required fields. Save your changes and download the updated document.
Add your legally-binding signature.
PrintFriendly allows you to sign PDFs effortlessly. Upload your PDF and add your signature using our signature tool. Save and download the signed document for submission.
Share your form instantly.
On PrintFriendly, sharing your PDF is simple. After editing, use our sharing features to email the document or generate a shareable link. You can also save it to your preferred cloud storage service.
How do I edit the Minnesota CDL Medical Self-Certification Form online?
You can easily edit this PDF on PrintFriendly. Simply upload the document and use our robust editing tools to fill in required fields. Save your changes and download the updated document.
1
Upload the PDF file to PrintFriendly.
2
Select the fields you need to edit.
3
Fill in the required information.
4
Review and save your changes.
5
Download the edited PDF.
What are the instructions for submitting this form?
Complete and submit the self-certification form along with your medical examiner's certificate. Mail to: Driver and Vehicle Services Division, 445 Minnesota Street, Suite 175, St. Paul, MN 55101-5175. Fax to (651) 297-4447. Submit in person at any driver exam station or driver license office that accepts applications. It is advisable to check the Driver and Vehicle Services Website for a list of locations and detailed instructions. Ensure all fields are properly filled out and signed before submission to avoid processing delays.
What are the important dates for this form in 2024 and 2025?
CDL holders must ensure they complete and submit their self-certification form by their license renewal date or any changes in status in 2024 and 2025.
What is the purpose of this form?
The purpose of this form is to ensure all commercial driver's license (CDL) holders in Minnesota are in compliance with state and federal medical requirements. By completing this form, drivers self-certify their operating status and, if applicable, submit a medical examiner's certificate. This helps the Department of Public Safety verify that CDL holders meet the necessary medical standards for safe driving.
Tell me about this form and its components and fields line-by-line.
- 1. Print Name: Enter the driver's full name (First, Middle, Last).
- 2. Date of Birth: Enter the driver's date of birth in mm/dd/yyyy format.
- 3. Minnesota Driver's License Number: Enter the driver's Minnesota Driver's License Number.
- 4. Self-Certification Category: Check only one category that applies to the driver.
- 5. Medical Certificate Submission: Indicate if submitting a medical examiner's certificate.
- 6. Medical Waiver Submission: Indicate if submitting a medical waiver.
- 7. Driver's Signature: The driver must sign the form.
- 8. Date: Enter the date the form is signed.
What happens if I fail to submit this form?
Failure to submit this form may result in the suspension or revocation of your commercial driving privileges.
- Driving Privileges: Non-compliance can lead to suspension or revocation of your CDL.
- Legal Consequences: You may face legal actions due to non-compliance with state and federal laws.
How do I know when to use this form?
- 1. Initial Certification: When applying for a CDL for the first time.
- 2. License Renewal: When renewing an existing CDL.
- 3. Change in License Class: When upgrading or changing the class of your CDL.
- 4. Change in Medical Status: When there are changes in your health condition.
- 5. Change in Interstate/Intrastate Status: When your operating status changes from interstate to intrastate or vice versa.
Frequently Asked Questions
Can I fill out this form online?
Yes, you can fill out this form online using PrintFriendly's PDF editor.
How do I submit this form after filling it out?
Submit the completed form by mail, fax, or in person as specified in the form instructions.
Can I sign the form using PrintFriendly?
Yes, you can add your signature to the form using PrintFriendly's signature tool.
How do I add information to the PDF?
Use PrintFriendly's editing tools to click on the fields and enter your information.
Is there a way to save my progress?
Save your edited form frequently and download it once completed to avoid losing any information.
What if I need to make changes after saving?
You can re-upload the saved PDF to PrintFriendly and make further edits as needed.
Can I share the edited PDF with others?
Yes, use PrintFriendly's sharing options to email or generate a link for the edited PDF.
Can I edit the Tennessen Warning section?
No, the Tennessen Warning section is for informational purposes and should not be edited.
Do I need to submit additional documents with this form?
Depending on your certification category, you may need to submit a medical examiner's certificate or a medical waiver.
Where can I find more information about this form?
Check the Minnesota Department of Public Safety's website for additional details and updates.
Related Documents - MN CDL Medical Form
Preparticipation Physical Evaluation Form
The Preparticipation Physical Evaluation Form is used to assess the physical health and fitness of individuals before they participate in sports activities. It covers medical history, heart health, bone and joint health, and other relevant medical questions.
Health Insurance Tax Credits Guide 2015
This document provides a comprehensive guide on health insurance and premium tax credits for the 2015 tax year. It explains the tax filing rules, eligibility criteria, and detailed instructions for claiming and reporting premium tax credits. Essential for individuals who bought health insurance through the ACA Marketplaces.
TSP-77 Partial Withdrawal Request for Separated Employees
The TSP-77 form is used by separated employees to request a partial withdrawal from their Thrift Savings Plan account. It includes instructions for completing the form, certification, and notarization requirements. The form must be filled out completely and submitted along with necessary supporting documents.
Ray's Food Place Donation Request Form Details
This file contains the donation request form for Ray's Food Place. Complete the general information section and follow the guidelines to submit your donation request at least 30 days in advance. The form includes fields for organization details and donation specifics.
Pastoral Ministry Evaluation Form for Board of Elders
This evaluation form is designed for the Board of Elders to assess and provide feedback on a pastor's ministry. It aims to offer affirmation and identify areas for improvement. The form covers preaching, worship leading, pastoral care, administration, and more.
Health Provider Screening Form for PEEHIP Healthcare
This file contains the Health Provider Screening Form for PEEHIP public education employees and spouses. It includes instructions on how to fill out the form for wellness program participation. The form collects personal, medical, and screening details to assess wellness.
Common Law Marriage Declaration Form for FEHB Program
This form is used to declare a common law marriage for the purpose of enrolling a spouse under the Federal Employees Health Benefits (FEHB) Program. It requires personal details, marriage information, and additional documentation. Submission instructions and legal implications are included.
MyPRALUENT™ Enrollment Form Instructions and Details
This document provides comprehensive instructions and details for enrolling in the MyPRALUENT™ program, including benefits, patient assistance, and clinical support. It outlines the required patient, insurance, and prescriber information, as well as the steps for treatment verification and household income documentation.
Application for Certified Copy of Birth Certificate
This form is used to request a certified copy of a birth certificate from the Clerk of Court Office. It includes details about the applicant, the person named on the certificate, and requires a photo ID and the correct fee. This form is only for walk-in services.
Torrance Memorial Physician Network Forms for Patients 18+
This file contains important forms for patients 18 years and older registered with Torrance Memorial Physician Network. It includes patient registration, acknowledgment of receipt of privacy practices, and financial & assignment of benefits policy forms. Complete these forms to ensure your medical records are up-to-date and to understand your financial responsibilities.
Vodafone Phone Unlocking Guide: Steps to Unlock Your Phone
This guide from Vodafone provides a step-by-step process to unlock your phone. Learn how to obtain your unlock code by filling out an online form. Follow the instructions to complete the unlocking process.
Texas Automobile Club Agent Application Form
This file is the Texas Automobile Club Agent Application or Renewal form, which must be submitted within 30 days after hiring an agent. The form includes fields for agent identification, moral character information, and requires signature from both the agent and an authorized representative of the automobile club. Filing fees and submission instructions are also provided.
