Occupational Driver's License Client Information Sheet
Full Legal Name:
Resident of county:
Dallas
Date of birth:
January
February
March
April
May
June
July
August
September
October
November
December
01
1920
Driver's License #:
State:
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
County of DWI Arrest:
Dallas
Date of DWI Arrest:
January
February
March
April
May
June
July
August
September
October
November
December
01
2000
DWI Case Number:
Occupation:
Did you give breath or blood?:
Yes
No
Reasons allowed to drive are:
To and from work
If work requires you to drive
To an educational facility in which you are enrolled
To Church or Synagogue
To any court ordered activity
For essential household duties:
Grocery store
Pharmacy
Pay bills
Doctor
Lawyer
etc.
YOU CANNOT DRIVE FOR SOCIAL ACTIVITY!!!!!
I understand the reasons allowed to drive:
Yes
For reasons listed above, you would be allowed to drive for up to
12 hours during a calendar day
. Select the hours you need to drive below:
Monday:
From:
-
Until:
-
From:
-
Until:
-
Total: 0:00hrs
tuesday:
From:
-
Until:
-
From:
-
Until:
-
Total: 0:00hrs
wednesday:
From:
-
Until:
-
From:
-
Until:
-
Total: 0:00hrs
thursday:
From:
-
Until:
-
From:
-
Until:
-
Total: 0:00hrs
friday:
From:
-
Until:
-
From:
-
Until:
-
Total: 0:00hrs
saturday:
From:
-
Until:
-
From:
-
Until:
-
Total: 0:00hrs
sunday:
From:
-
Until:
-
From:
-
Until:
-
Total: 0:00hrs
Counties:
Select the Texas counties you need to drive in during the suspension period:
County:
-
County:
-