Illinois Form DSD CDTS 122: CDL Safety Officer License App

Illinois Form DSD CDTS 122: CDL Safety Officer License App – The Illinois Secretary of State’s Driver Services Department issues Form DSD CDTS 122 for individuals seeking a Safety Officer License under the state’s CDL Third-Party Certification Program. This official application allows qualified employees of licensed third-party entities to administer Commercial Driver’s License (CDL) skills and road tests to their organization’s employees or members.

Private companies, municipalities, fire departments, and other governmental agencies in Illinois (and certain contiguous states) participate in this program so they can efficiently test workers who need a CDL for daily job operations. The program is governed by Illinois administrative rules and federal standards under 49 CFR Part 383.

Official download link: Download Illinois Form DSD CDTS 122 (PDF)

What Is the CDL Third-Party Certification Program?

The Illinois Secretary of State licenses and regulates third-party entities that conduct CDL skills tests for Classes A, B, C, and M. These tests cover basic vehicle control skills and the road test required under federal regulations (subparts G and H of 49 CFR 383).

A third-party certifying entity may only test its own employees or members (for unions or fire departments). The entity must maintain at least one licensed Safety Officer and meet strict facility, recordkeeping, and auditing requirements. Safety Officers are equivalent to third-party skills test examiners under federal law.

For complete program details, visit the official Illinois Secretary of State Third-Party Certification Program page.

Purpose of Form DSD CDTS 122

Form DSD CDTS 122 is the official application used by an individual to obtain a CDL Third-Party Certification Program Safety Officer License. The license authorizes the holder to administer CDL skills tests solely for the specific third-party entity named on the license.

Key purposes include:

  • Collecting the applicant’s personal and driver’s license information
  • Screening driving and criminal history through required questions
  • Identifying the vehicle classes, passenger/school bus endorsements, and restriction removals the applicant intends to test
  • Securing signatures from both the applicant and an authorized official of the third-party entity

The form is fillable PDF format. Download it, complete it on a computer using Adobe Acrobat Reader for best results, print, and submit the signed original.

Who Needs to Complete Form DSD CDTS 122?

Any person employed by a licensed third-party certification entity who will administer CDL skills tests must hold a valid Safety Officer License issued via this form. Requirements include:

  • Employment by a properly licensed third-party entity
  • Completion of a CDL skills test examiner training course and examination that meets federal standards (49 CFR 384.228)
  • Meeting all qualifications outlined in Illinois Administrative Code Title 92, Section 1030.60
  • Not currently being employed by a commercial driver training school in a conflicting capacity (as disclosed on the form)

A Safety Officer may only test and certify employees or members in the classification(s) listed on their individual license. The license is non-transferable and tied to the named employer.

Information Required on Form DSD CDTS 122

The application requests the following details:

  • Applicant’s full name, home address, home phone, city, state, ZIP, and driver’s license number
  • Name, address, phone, and email of the third-party certification entity for which the applicant will test
  • Yes/No answers to background questions covering:
    • Convictions for DUI, leaving the scene of an accident, reckless homicide, or reckless driving
    • Suspensions related to repeated collisions, Implied Consent, or Statutory Summary Suspension
    • Felony convictions or misdemeanors involving fraud
    • Prior driver’s license denials, cancellations, suspensions, or revocations
    • Prior Safety Officer License actions
    • Current employment by a commercial driver training school
  • Explanations for any “Yes” answers (sealed or expunged records need not be disclosed)
  • Intended testing classifications: Class A, B, or C
  • Passenger and/or School Bus testing authority
  • Restriction removals: No Air Brake (L), No Full-Air Brake (Z), No Tractor-Trailer (O), No Manual Transmission (E)

The applicant must affirm under penalty of perjury that all information is true. An authorized official of the third-party entity must also sign the form.

Agreements and Obligations on the Form

By signing Form DSD CDTS 122, the applicant agrees that:

  1. If employment with the named third-party entity ends, the Safety Officer License must be surrendered.
  2. If the applicant later works for a different third-party entity, a new application for a Safety Officer License specific to that entity is required.

These provisions ensure each license remains tied to a single employer and maintains program integrity.

How to Submit Form DSD CDTS 122?

Completed applications and supporting documents for the Third-Party Certification Program are mailed to:

Illinois Secretary of State
Commercial Driver Training Section
1800 W Hawthorne Ln.
West Chicago, IL 60185

After documents are received, the Commercial Driver Training Section contacts the entity to schedule required training. For questions, call 630-520-9310.

Related forms often submitted together include:

  • Application for CDL Third-Party Certification Entity License (DSD CDTS 121)
  • Agreement Between the Illinois Secretary of State and Driver’s License Third-Party Certification Entity (DSD CDTS 77)
  • Surety Bond Form (DSD CDTS 119)
  • Two-Week Training Form (DSD CDTS 124)
  • Road test route narrative and diagrams

View the full list of commercial driver forms on the Illinois Secretary of State Commercial Drivers Publications and Forms page.

Key Requirements for Safety Officers Under Illinois Rules

According to Illinois Administrative Code Title 92, Section 1030.60:

  • A Safety Officer License authorizes testing only in the class(es) indicated on the license.
  • Safety Officers who administer CDL skills tests must complete federally required examiner training and a refresher course with written examination every four years.
  • A Safety Officer may not administer a skills test to any individual who received skills training from that same officer.
  • Entities and officers must allow random inspections and audits by the Illinois Secretary of State and the Federal Motor Carrier Safety Administration (FMCSA).
  • Detailed testing records must be retained for four years at the licensed location.

Full regulatory text is available via the Legal Information Institute (Cornell Law) version of Ill. Admin. Code tit. 92, § 1030.60.

Tips for a Successful Application

  • Download the latest official PDF directly from the Illinois Secretary of State website to ensure you have the current version.
  • Answer all background questions completely and provide explanations where required.
  • Confirm that your third-party entity already holds or is simultaneously applying for its entity license.
  • Coordinate with your employer so the authorized official signature is obtained promptly.
  • Prepare any required supporting materials (training documentation, facility details) before mailing.
  • Keep copies of everything submitted for your records.

Additional Resources from Official Sources

Always verify information on the official Illinois Secretary of State website (ilsos.gov), as requirements and forms can be updated. This guide is based on publicly available materials from the Illinois Secretary of State and applicable administrative rules current as of the latest published versions.

For the most accurate and up-to-date guidance, contact the Commercial Driver Training Section at 630-520-9310 or consult the official resources linked above.

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