Fillable Form DMV West Virginia Driver's License Application (2018)

What is the West Virginia Driver's License Application Form?

Form DMV-DS-23P, Application for a Driver's License or Identification Card, or the West Virginia Driver's License Application Form is a form used by new residents, alien citizens, and first-time drivers to apply for a state identification card or driver's license in West Virginia.

How to fill out the West Virginia Driver's License Application Form?

Enter all applicable information on your West Virginia Driver's License Application Form. If incomplete, your application will not be processed.

Name

Enter your name.

Former Names

Enter your former names, if applicable.

Residence Address

Enter your street address and apartment number.

Mailing Address

Enter your mailing address.

City, State, ZIP code

Enter the city, state, and ZIP code where you live.

Social Security Number

Enter your Social Security Number.

WV License #

Enter your West Virginia license number.

Birth date

Enter your birthdate.

Gender

Enter your gender.

Weight

Enter your weight in pounds.

Height

Enter your height.

Eye Color

Enter your eye color.

Do your wear corrective lenses?

Mark the first box if you wear corrective lenses. If not, mark the second box.

Daytime Phone

Enter your daytime phone number.

Cellular Phone

Enter your cellular number.

Email Address

Enter your email address.

Reminder:

If you do not meet the question's criteria below, leave it blank.

Has your address changed since your last License/ID issuance?

Mark Yes if your address has changed since your last license or identification issuance. Then, enter your previous address. If not, mark No.

Are you a U.S. Citizen? If not, list your Alien Registration Number below.

Mark Yes, if you are a U.S. citizen. If not, mark No. Then, enter your Alien Registration Number.

Have you been issued a license/ID in another jurisdiction in the last 10 years?

Mark Yes, if you have been issued a license or ID in another jurisdiction in the last ten years. Then, enter the jurisdiction and the license or ID number. If not, mark No.

Do you have a suspended/revoked license or a pending license suspension/revocation in ANY jurisdiction within the previous five years?

Mark Yes, if you have a suspended or revoked license or a pending license suspension or revocation in any jurisdiction within the previous five years. Then, provide a letter of explanation of the incident, including its date. If not, mark No.

Have you been refused a license by any jurisdiction within the previous five years?

Mark Yes, if you have been refused a license by any jurisdiction within the previous five years. Then, provide a letter of explanation of the incident, including its date. If not, mark No.

APPLICANTS THAT OWE A CHILD SUPPORT OBLIGATION ONLY: Do you owe an obligation that is more than six months in arrears?

Complete this item if you are an applicant who owes a child support obligation.

Mark Yes, if you owe an obligation that is more than six months in arrears. If not, mark No.

APPLICANTS THAT OWE A CHILD SUPPORT OBLIGATION ONLY: Are you the subject of a child support-related warrant, subpoena, or court order?

Complete this item if you are an applicant who owes a child support obligation.

Mark Yes, if you are a subject of child support-related warrant, subpoena, or court order. If not, mark No.

LEVEL 2 GDL Applicants ONLY: Have you been convicted of a traffic violation in the past six months?

Complete this item if you are a level two graduated driver's license applicant.

Mark Yes, if you have been convicted of a traffic violation in the past six months. If not, mark No.

LEVEL 3 GDL Applicants ONLY: Have you been convicted of a traffic violation in the past 12 months?

Complete this item if you are a level three graduated driver's license applicant.

Mark Yes, if you have been convicted of a traffic violation in the past 12 months. If not, mark No.

Do you have any visual/medical condition(s) affecting your ability to drive safely?

Mark Yes if you have any visual or medical conditions affecting your ability to drive safely. Then, provide a letter of explanation. If not, mark No.

Do you wish to be designated on your license as an organ donor?

Mark Yes, if you wish to be designated on your license as an organ donor. If not, mark No.

Do you wish to be designated on your license as diabetic?

Mark Yes if you wish to be designated on your license as diabetic. Then, let a licensed physician certify your condition and complete the Medical Endorsement section on your West Virginia Driver's License Application Form. If not, mark No.

Do you wish to be designated on your license as hearing impaired?

Mark Yes if you wish to be designated on your license as hearing impaired. Then, let a licensed audiologist certify your condition and complete the Medical Endorsement section on your West Virginia Driver's License Application Form. If not, mark No.

Veterans of the United States Military ONLY: Do you wish to have the United States Veterans designation on your license?

Complete this item if you are a veteran of the United States military.

Mark Yes, if you wish to have the United States Veterans designation on your license. If not, mark No.

If you marked Yes, the Department of Motor Vehicles must verify your status with your Form DD 214, Discharge Papers and Separation Documents, Form WD AGO 53, Enlisted Record and Report of Separation Honorable Discharge, Form WD AGO 55, Honorable Discharge from The Army of the United States, Form WD AGO 53-55, Enlisted Record and Report of Separation Honorable Discharge, Form NAVPERS-553, Notice of Separation from U.S. Naval Service, Form NAVMC 78PD, U.S. Marine Corps Report of Separation NAVCG 553, Military Identification Card, or Current Military license plate registration card.

Have you ever experienced seizures or loss of consciousness, emotional or mental illness, alcohol or drug problems, or any physical condition that requires you to use special equipment to drive?

Mark Yes, if you have experienced seizures or loss of consciousness, emotional or mental illness, alcohol or drug problems, or any physical condition that requires you to use special equipment to drive. Then, provide a letter of explanation. If not, mark No.

Ages 18 and up ONLY: Do you wish to register to vote?

Complete this item if you are age 18 or older.

Mark Yes if you wish to register to vote. If no, mark No.

Do you wish to make a contribution to the West Virginia State Police Forensic Laboratory Fund?

Mark Yes if you wish to make a contribution to the West Virginia State Police Forensic Laboratory Fund. Then, enter the amount. If not, mark No.

Do you wish to make a contribution to the West Virginia Department of Veterans Assistance?

Mark Yes, if you wish to make a contribution to the West Virginia Department of Veterans Assistance. Then, mark the amount. You may choose $3, $5, or $10.

If not, mark No.

TYPE OF LICENSE / ID APPLICANT WISHES TO OBTAIN

Mark the type of license or identification you want to obtain. You can mark one of the following:

• Instruction Permit
• Skills Test
• Level 3 License
• Instruction Permit "E"
• Skills Test E
• Instruction Permit F
• Motorcycle Skills
• Motorcycle Endorsement
• Transfer
• Renewal
• Duplicate license
• "For Federal Identification Federally Compliant Card"
• Child ID Card
• ID Card
• Secondary ID Card

PHYSICIAN / AUDIOLOGIST CERTIFICATION FOR MEDICAL ENDORSEMENT

If you want to be designated on your license as diabetic or hearing impaired, let a physician or audiologist fill out this section.

Mark Diabetic if the applicant is diabetic.

Mark Deaf if the applicant is deaf.

Mark Hard of Hearing if the applicant's ability to hear is poor.

SIGNATURE (Physician for diabetic or audiologist for deaf/hard of hearing)

Enter your signature.

MEDICAL LICENSE NUMBER

Enter your medical license number.

STATE

Enter the state where you are registered as a licensed physician or audiologist.

ADDRESS

Enter the street, city, and ZIP code you are registered as a licensed physician or audiologist.

BUSINESS PHONE NUMBER

Enter your business phone number.

AFFIDAVIT OF WEST VIRGINIA RESIDENCY

This section is for your homeowner's use only.

FULL NAME OF HOMEOWNER

Enter your name.

FULL NAME OF APPLICANT

Enter the name of the applicant.

STREET ADDRESS

Enter the street address where the applicant lives.

CITY

Enter the city where the applicant lives.

STATE

Enter the state where the applicant lives.

ZIP CODE

Enter the ZIP code where the applicant lives.

SIGNATURE OF HOMEOWNER

Enter your signature.

WV DRIVER’S LICENSE/ID NUMBER

Enter your West Virginia driver's license or identification number.

DATE

Enter the date upon signing the West Virginia Driver's License Application Form.

Applicant's use:

APPLICANT SIGNATURE

Enter your signature. By signing the West Virginia Driver's License Application Form, you certify that all information is true and correct, and you adhere to the requirements regarding your application.

DATE

Enter the date upon signing the West Virginia Driver's License Application Form.

PARENT/GUARDIAN SIGNATURE

If you are under age and applying for an instruction permit, your parent or guardian must sign your West Virginia Driver's License Application Form.

DATE

Enter the date your parent signed the West Virginia Driver's License Application Form.

THE REMAINDER OF THIS APPLICATION IS TO BE COMPLETED BY THE WVDMV

Do not enter anything beyond this line.

How to file the West Virginia Driver's License Application Form?

Submit your accomplished West Virginia Driver's License Application Form to the West Virginia Department of Motor Vehicles (WVDMV) office.

What is a Graduated Driver's License?

A Graduated Driver's License (GDL) is a temporary license for teen drivers. It has a three-level approach to grant young or teen drivers full license privileges.

What are the three Graduated Driver's License levels?

GDL consists of three levels — one, two, and three.

Level 1. Level 1 GDL is a supervised learner's license issued to young drivers at least 14 years and nine months old.

To get Level 1 GDL, you must submit:

• Segment 1 Certificate of Completion;
• Proof of a valid Social Security number;
• U.S. citizenship or legal presence if not a U.S. citizen;
• Identity and at least two documents establishing U.S. residency; and
• Parent or guardian's signature.

Level 2. Level 2 GDL is an intermediate license that limits unsupervised nighttime driving for teen drivers at least 16 years old.

To obtain a level two GDL, you need to submit:

• Segment 2 Certificate of Completion;
• Level 1 License that was held for six months;
• Proof of a valid Social Security Number;
• Legal presence;
• Identity;
• Two U.S. residency evidence;
• Driving Skills Test Certificate; and
• Parent or guardian's signature.

Level 3. Level 3 GDL is a full-privilege driver license automatically issued to teen drivers at least 17 years if they completed Level 1 and 2 GDLs.