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Get Navmc 10964 1996-2024

U.S. DOD Form dod-navmc-10964 APPLICATION FOR GOVERNMENT VEHICLE OPERATOR S PERMIT 11240 NAVMC 10964 REV. 2-96 EF Previous editions are obsolete SN 0109-LF-064-7800 Supersedes NAVFAC FORM 9-11240/10 FOR USMC use. PART I APPLICATION 2. RANK 1. NAME Last First Middle 5. SEX 6. HEIGHT 3. SSN 4. ORGANIZATION 8. EYE COLOR 9. HAIR COLOR 7. WEIGHT 11. DOB 10. PLACE OF BIRTH PAST DRIVING RECORD 12. STATE OF ISSUE 13. LICENSE NUMBER 15. EXP. DATE 14. ISSUE DATE 16. CLASS OF VEHICLE 17. COMMANDING OFFICER S SIGNATURE I RECOMMEND THAT THIS INDIVIDUAL BE EXAMINED FOR QUALIFICATION TO HOLD THE OF 346 Signature Date PART II EXAMINATION 18. QUALIFICATION TESTS CHECK TEST SAT UNSAT PHYSICAL HEARING VISION WRITTEN REACTION TIME SKILL ROAD DIRT/CROSS COUNTRY SPECIAL QUALIFICATION 19. RESTRICTIONS CHECK HERE IF NONE List PART III LICENSE ACTION 20. CATEGORY Check One NEW RENE 21. CLASS OF LICENSE Check all that apply UPGRADE DUPLICATE COMMERCIAL TACTICAL BUS TRACTOR 22. CLASSES OF VEHICLES Check all that apply SEDANS/STATION WAGONS TRUCKS TO 23. SPECIAL QUALIFICATIONS SEMITRAILER REFUELER TON EMERGENCY VEHICLE RECOVERY VEHICLE TRUCK-TRACTOR TO BUSSES TO PASS TRUCK WITH FULL TRAILER HAZARDOUS MATERIALS OTHER SPECIFY 24. VEHICLE/EQUIPMENT CLASSES QUALIFIED TO OPERATE LIST 25. SIGNATURE OF LICENSING EXAMINER I CERTIFY THAT THIS INDIVIDUAL IS QUALIFIED TO OPERATE THE ABOVE LISTED EQUIPMENT. 26. LICENSE ISSUED 28. EXPIRATION DATE 27. DATE ISSUED DATE PART IV RECORDING ACTION 30. RECORDING OFFICER S SIGNATURE I CERTIFY THAT ALL THE INFORMATION IN BLOCKS 19 20 23 24 26 AND 28 HAVE BEEN ENTERED ON PAGE 11 OF THE INDIVIDUAL S SRB/OQR SIGNATURE Designed Using FormFlow 2. 2-96 EF Previous editions are obsolete SN 0109-LF-064-7800 Supersedes NAVFAC FORM 9-11240/10 FOR USMC use. PART I APPLICATION 2. RANK 1. NAME Last First Middle 5. SEX 6. HEIGHT 3. SSN 4. ORGANIZATION 8. EYE COLOR 9. PART I APPLICATION 2. RANK 1. NAME Last First Middle 5. SEX 6. HEIGHT 3. SSN 4. ORGANIZATION 8. EYE COLOR 9. HAIR COLOR 7. WEIGHT 11. DOB 10. PLACE OF BIRTH PAST DRIVING RECORD 12. STATE OF ISSUE 13. LICENSE NUMBER 15. HAIR COLOR 7. WEIGHT 11. DOB 10. PLACE OF BIRTH PAST DRIVING RECORD 12. STATE OF ISSUE 13. LICENSE NUMBER 15. EXP. DATE 14. ISSUE DATE 16. CLASS OF VEHICLE 17. COMMANDING OFFICER S SIGNATURE I RECOMMEND THAT THIS INDIVIDUAL BE EXAMINED FOR QUALIFICATION TO HOLD THE OF 346 Signature Date PART II EXAMINATION 18. EXP. DATE 14. ISSUE DATE 16. CLASS OF VEHICLE 17. COMMANDING OFFICER S SIGNATURE I RECOMMEND THAT THIS INDIVIDUAL BE EXAMINED FOR QUALIFICATION TO HOLD THE OF 346 Signature Date PART II EXAMINATION 18. QUALIFICATION TESTS CHECK TEST SAT UNSAT PHYSICAL HEARING VISION WRITTEN REACTION TIME SKILL ROAD DIRT/CROSS COUNTRY SPECIAL QUALIFICATION 19. QUALIFICATION TESTS CHECK TEST SAT UNSAT PHYSICAL HEARING VISION WRITTEN REACTION TIME SKILL ROAD DIRT/CROSS COUNTRY SPECIAL QUALIFICATION 19. RESTRICTIONS CHECK HERE IF NONE List PART III LICENSE ACTION 20. CATEGORY Check One NEW RENE 21. CLASS OF LICENSE Check all that apply UPGRADE DUPLICATE COMMERCIAL TACTICAL BUS TRACTOR 22. .

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