ATDS+Application

Application

Date *
Date
Today's Date
Name *
Name
Address *
Address
Phone *
Phone
include state, class, and expiration date
Birthday *
Birthday
Sex *
Are you currently working? *
Do you have a high school diploma or GED? *
May request a copy if applicable
Do you have any careless/reckless driving charges in the past 3 years? *
Have you had any moving violations in the last 3 years? *
Have you had any traffic/vehicle accidents in the last 3 years? *
Have you ever had your driver’s license suspended? *
Have you ever been convicted of DWI or DUI? *
Have you ever had a misdemeanor conviction? *
Have you ever had a felony conviction? *
Have you ever had any alcohol/drug violations? *
Have you ever held a driver’s license from any state other than Texas? *
Have you ever been in the military? *
Confirm *
FOR OFFICE USE ONLY
for office use only
For office use only
For office use only
For office use only
For office use only
Qualified
For office use only

I have read the entire foregoing application, and all answers, statements, and all other matter therein are true in substance and in fact. I also request as abstract copy of my driving record to be forwarded to ATDS at the above address.