CDL Holder Self-Certification - New Jersey Motor Vehicle Commission - Medical Certificate Affidavit

Sep 18, 2026

Upload by Eden

New Jersey Motor Vehicle Commission CDL Holder Self-Certification affidavit collects a driver’s identity and medical certificate submission status for CDL renewal. It guides drivers to circle whether they are submitting a copy and then select the applicable self-certification category based on operating scope and federal or state requirements. The form specifies when a medical certificate and affidavit must be submitted for Categories 1–4, including special cases such as federal exemptions, passenger endorsements, and certain limited operations, then provides signature and date fields.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

CDL Holder Self-Certification

Driver information and yes/no submission

Self-certification categories (1-4)

Signature and date

New Jersey Motor Vehicle Commission CDL Holder Self-Certification Name of Driver: New Jersey Driver License Number: Are you submitting a copy of your medical certificate? YES NO (please circle yes or no) Note: Only Class A, B, or C drivers that check the box for category 1 or 3 self-certification below must submit a copy of their medical certificate; however all CDL holders, Class A, B, or C drivers must submit this affidavit. Please check only one of the following Self-Certification categories that apply to you. I certify my commercial transportation is: Category 1: Interstate and subject to 49 C.F.R. part 391. (Medical certificate and affidavit must be submitted) • All Class A, B, and C drivers who do NOT fall under any of the other categories. • All Class A, B, and C drivers granted a federal vision or diabetes exemption; or SPE-limb impairment Skill Performance Evaluation. Category 2: Interstate but operating exclusively in transportation or operations excepted under 49 C.F.R. 390.3(f), 391.2, or 391.68 (Affidavit must be submitted) . • Transportation performed by the federal government, a state, or any political subdivision of a state. (Note: The Motor Vehicle Commission requires ALL P (passenger) endorsement holders, including government workers, to submit a valid medical certificate in order to maintain the P endorsement on their CDL. N.J.A.C. 13:21-14.5(c) (6) • The transportation of human corpses or sick and injured persons. • The operation of fire trucks and rescue vehicles while involved in emergency and related operations. • Apiarian industries (Beekeepers) . • Farm vehicle drivers operating within a 150 mile radius of the farm. Category 3: Intrastate and subject to state driver qualification requirements. (Medical certificate and affidavit must be submitted). • All Class A, B, and C drivers who do NOT fall under any of the other categories. Category 4: Intrastate, but operating exclusively in transportation or operations excepted from all or part of the state driver qualification requirements. (Affidavit must be submitted) . • Transportation performed by the federal government, a state, or any political subdivision of a state. (Note: The Motor Vehicle Commission requires ALL P (passenger) endorsement holders, including government workers, to submit a valid medical certificate in order to maintain the P endorsement on their CDL. N.J.A.C. 13:21-14.5(c) (6) • The transportation of human corpses or sick and injured persons. • The operation of fire trucks and rescue vehicles while involved in emergency and related operations. • Apiarian industries (Beekeepers) . • Farm vehicle drivers operating within a 150 mile radius of the farm. Driver’s Signature Date New Jersey Motor Vehicle Commission CDL/Bus Unit PO Box 685 Trenton, NJ 08666 On the Road to Excellence Visit [us at www.njmvc.gov](us at www.njmvc.gov)[ ](us at www.njmvc.gov)New Jersey is an Equal Opportunity Employer

FAQs

What does the New Jersey CDL Holder Self-Certification require you to do?

You must provide the driver’s name and information, circle whether you are submitting a copy of your medical certificate, and select the self-certification category that applies to your operations.

When must a medical certificate and affidavit be submitted for Category 1?

Category 1 covers interstate operations subject to 49 C.F.R. part 391; it requires submission of the medical certificate and affidavit. The form notes additional groups (such as drivers not in other categories, and those with certain federal vision or diabetes exemptions).

Are passenger endorsement holders required to submit a medical certificate?

Yes. The form states that all P (passenger) endorsement holders, including government workers, must submit a valid medical certificate to maintain the P endorsement on their CDL.

Sep 18, 2026

Upload by Eden