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Do NOT write in this space. DEPARTMENT OF EDUCATION PHYSICAL EXAM FORM FOR SCHOOL BUS DRIVER LICENSE ENDORSEMENT Refer to the INSTRUCTION SHEET to fill out this form and provide it to your physician at the time of your physical. Available at http //maine. SECTION 1 Applicant Information and Authorization To be filled out by the applicant. PRINT CLEARLY Applicant s Full Name Date of Birth Sex Maine 7-Digit Driver License M Street/P. O. Box City .

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