(a) The application for a commercial driver's license or commercial driver's instruction permit must include at least the following:

1. (1) The full name and current mailing and residential address of the person;
2. (2) A physical description of the person including sex, height, weight and eye color;
3. (3) Date of birth;
4. (4) The applicant's social security number;
5. (5) The person's signature;
6. (6) The person's color photograph;
7. (7) Certifications including those required by 49 C.F.R. Part § 383.71(a)(2004);
8. (8) Any other information required by the commissioner;
9. (9) A consent to release driving record information; and

10. (10) Certification stating that the applicant is:

    1. (A) Engaged in interstate commerce and subject to 49 C.F.R. Part §391 standards;
    2. (B) Engaged in interstate commerce but excepted from 49 C.F.R. Part §391 standards;
    3. (C) Engaged in intrastate commerce and subject to state medical standards; or
    4. (D) Engaged in intrastate commerce but not subject to state medical standards.