10 Year History Record Check DL 939
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The Motor Carrier Safety Improvement Act of 1999, and applicable Federal Regulations requires all commercial driver license applicants including renewal applications to disclose whether he or she has been issued a driver license in the same or different name to operate any type of motor vehicle in another state or other jurisdiction within the previous ten years. If it is determined that the information provided has been falsified, the State may suspend, cancel, revoke my commercial driver license, or pending application, or disqualify you from operating a commercial motor vehicle for a period of at least 60 consecutive days
All sections must be completed.
Section A. Requires you to provide your:
- California Driver License information
- Your first, middle, and last name including suffix if applicable as it appears on your California driver license or Commercial Driver License Application (DL 44C)
Section B. Other State/jurisdiction Driver License Information
The state (two letter state code) or jurisdiction where you held a driver license to operate any type of motor vehicle.
- The driver license number (If the state or other jurisdiction license number is not available or you don’t know, write unknown)
- Social Security Number (NNN-NN-NNNN)
- Birthdate (MM/DD/YY)
- Sex: Check appropriate box
- Your first, middle, and last name including suffix if applicable, (if same or different)
Section C. Certification and Acknowledgement Statement
- Read the certification and acknowledgement statement
- Sign and Date in the spaces provided
Submit your completed 10 Year History Record Check form (DL 939) with your Commercial Driver License Application (DL 44C) or bring your completed Driver License Ten Year History Record Check renewal form (DL 10Y) if renewing in person or include with the bottom portion of your renewal by mail notice if renewing by mail.Back to Main form page