Structure
The Connecticut A 62 form serves as a crucial application for individuals seeking a special permit to operate a motor vehicle for work-related purposes while their regular driver's license is suspended. This form is specifically designed for those who face significant hardships without the ability to commute to their places of employment. Applicants must provide detailed personal information, including their name, date of birth, and contact details, as well as specifics about their employer and work schedule. The form also requires a non-refundable application fee of $100, which must be submitted alongside the application. Notably, individuals with multiple jobs must complete separate applications for each position. Furthermore, the form stipulates that the applicant's driving record will be reviewed, and any violations could impact the approval process. It is essential for applicants to clearly outline their commuting distance, time, and any available public transportation options, as this information will be evaluated to determine the necessity of the permit. The A 62 form emphasizes the importance of adhering to the specified hours of operation and warns of the legal consequences of misuse. Understanding these requirements is vital for applicants aiming to secure their work-related driving privileges during a suspension period.
Connecticut A 62 Example
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DRIVER SERVICES DIVISION
60 STATE STREET, WETHERSFIELD, CT 06161-2530
TELEPHONE: (860) 263-5720 On The Web At ct.gov/dmv
APPLICATION FOR SPECIAL PERMIT TO
OPERATE A MOTOR VEHICLE TO AND FROM WORK
INSTRUCTIONS:
1. Please print or type.
2. Multiple employment requires separate applications.
3. A $100.00
Operation of motor vehicles requiring a CDL or used for Public Passenger Transportation is PROHIBITED under the Special Permit Program
YOUR OFFICIAL DRIVING RECORD WILL BE REVIEWED AS PART OF THIS APPLICATION.
NAME OF APPLICANT (Last, First, Middle)
DATE OF BIRTH
OPERATOR LICENSE NUMBER/STATE
SEX
M
F
MAILING ADDRESS |
(Number and Street) |
(City or Town) |
(State) |
(Zip Code) |
|
|
|
|
|
|
|
RESIDENCE ADDRESS (If different) |
(Number and Street) |
(City or Town) |
(State) |
(Zip Code) |
|
NAME OF EMPLOYER (If
ADDRESS OF EMPLOYER |
(Number and Street) |
(City or Town) |
(State) |
(Zip Code) |
OCCUPATION |
HOME TELEPHONE NUMBER |
( )
DAYS AND HOURS OF EMPLOYMENT (Specify A.M. or P.M.)
TO BE ISSUED A WORK PERMIT, YOUR SCHEDULE MUST BE CLEARLY IDENTIFIED, AND
MON.
TUE.
THU.
FRI.
SAT.
MAY NOT EXCEED A CONTINUOUS
IF YOU HAVE MORE THAN ONE PLACE OF
EMPLOYMENT, EACH EMPLOYER MUST
WED.SUN.
COMPLETE A SEPARATE APPLICATION.
What is the distance and the commuting time from your residence to your place of employment? |
Is public transportation available |
|
|
|
from your residence to your |
YES |
NO |
|
place of employment? |
||
|
|
|
|
What significant hardship(s) will you suffer without a Special Operator's Permit? |
|
|
|
What efforts have you made to obtain other transportation?
INABILITY TO CONFIRM YOUR EMPLOYMENT MAY RESULT IN DENIAL OF YOUR SPECIAL OPERATOR'S PERMIT.
PRINTED NAME OF SUPERVISOR
SIGNATURE OF SUPERVISOR
X
PRINTED JOB TITLE OF SUPERVISOR
WORK TELEPHONE
( )
NOTICE:
OATH:
Your operator's license is under suspension. If you operate any vehicle outside of the authorized hours, you may be subject to arrest. If you operate a motor vehicle for a purpose not authorized by law, a police officer may make a report to the Commissioner of Motor Vehicles and you will be subject to a civil penalty of up to $500. If your operator's license is suspended for another reason while you are in possession of this permit, the permit is revoked, and if you thereafter operate a motor vehicle you will be subject to double the penalties imposed by law. If you alter or make improper use of the permit, you will be subject to criminal penalties.
I swear or affirm under penalty of false statement in accordance with Connecticut General Statute
PRINTED NAME OF APPLICANT |
SIGNATURE OF APPLICANT |
DATE SIGNED |
X
DMV USE ONLY
PERMIT:
APPROVED
DENIED
DATE PERMIT ISSUED |
(If Approved) |
PERMIT VALID UNTIL (If Approved)
REASON FOR DENIAL
DRIVING HISTORY
NO SIGNIFICANT HARDSHIP
INELIGIBLE
OTHER (Provide Details)
AUTHORIZED SIGNATURE (DMV)
X
PRINTED NAME
DATE SIGNED
Document Specifications
| Fact Name | Detail |
|---|---|
| Governing Law | The Connecticut A 62 form is governed by Connecticut General Statutes § 14-36. |
| Purpose | This form is used to apply for a special permit to operate a motor vehicle to and from work while the applicant's license is suspended. |
| Application Fee | A non-refundable application fee of $100 must accompany each request for a permit. |
| Multiple Employment | If an applicant has multiple jobs, separate applications are required for each employer. |
| Prohibited Operations | Operation of vehicles requiring a Commercial Driver's License (CDL) or used for public passenger transportation is not allowed under this program. |
| Driving Record Review | The applicant's official driving record will be reviewed as part of the application process. |
| Work Schedule | The applicant's work schedule must be clearly identified and cannot exceed a continuous 12-hour period per day. |
| Public Transportation | Applicants must indicate whether public transportation is available from their residence to their place of employment. |
| Hardship Statement | Applicants must describe any significant hardships they would face without the special operator's permit. |
| Penalties | Operating a vehicle outside of authorized hours or for unauthorized purposes may result in civil penalties or criminal charges. |
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