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- Date of Birth*
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- Check all that apply
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- Check all that Apply
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- What led to the intoxication-related arrest?
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- I am seeking this occupational license in order to (check all that apply)
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- Check all that apply
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- The following is regarding your weekly work or school schedule. Check all that apply Further information for each selection will be required.
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- In order to: (check all that apply)
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- A second or subsequent conviction for Driving While Intoxicated (section 49.04, Penal Code), Intoxication Assault (Section 49.07, Penal Code), or Intoxication Manslaughter (Section 49.08, Penal Code), committed within five (5) years of a previous conviction for Driving While Intoxicated ( Section 49.04, Penal Code), Intoxication Assault (Section 49.07, Penal Code), or Intoxication Manslaughter (Section 49.08, Penal Code)
- In the Past five (5) years, my license has been suspended for:
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- I have obtained the following documents
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- Should be Empty: