CDL Vision Exemption
DDS‐VE1 (06‐08)
P a g e 1
Provide all of the requested information.
Part 1: Vital Statistics
Full Name (Last, First, Middle)
Mailing Address
City
State
Zip Code
Telephone Number
Driver’s License Number
Issue Date
Expiration Date
License Class (Type of vehicles that may be
operated if non‐CDL license)
Part 2: Experience
¾ Number of years driving straight trucks: __________________________________________
¾ Approximate number of miles per year driving straight trucks: ________________________
¾ Number of year driving tractor‐trailer combinations: ________________________________
¾ Approximate number of miles per year driving tractor‐trailer combinations: _____________
¾ Number of years driving buses: _________________________________________________
¾ Approximate number of miles per year driving buses: _______________________________
Part 3: Present Employment
Employer’s Name
Employers Address
City
State
Zip Code
Employer’s Telephone Number
Type of Vehicle Operated
GVWR
Estimated Number of
Miles Driven Per Week
Estimated Number of
Daylight Driving Hours
Per Week
Estimated Number
of Nighttime
Driving Hours Per
Week
Exemption Continued on Reverse
CDL Vision Exemption
DDS‐VE1 (06‐08)
P a g e 2
Part 4: Supporting Documentation
Your exemption application must be accompanied by the following supporting documents:
¾ A photo copy of both sides of your current driver’s license (CDL or non‐CDL).
¾ Documentation that you have been examined by an ophthalmologist or an optometrist in the last 3
months. This documentation can be a signed statement on letterhead by the ophthalmologist or
optometrist and must:
o
Identify and define the nature of the vision deficiency, including how long you have had the
deficiency;
o States the date of the examination;
o Certifies that the visual deficiency is stable;
o
Identifies the field of vision for each eye, including central and peripheral fields, testing to a