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The signature shall be WRITTEN in BLACK INK. ONCE THIS APPLICATION FORM AND FEE HAVE BEEN SUBMITTED, NO REFUNDS WILL BE MADE. Applications held only 90 days. |  |\n\nAPPLICATION for: DRIVER LICENSE  COMMERCIAL DRIVER LICENSE (CDL)   \nLEARNER LICENSE  IDENTIFICATION CARD   \nNON-RESIDENT COMMERCIAL DRIVER LICENSE   \n(Circle Class Desired)  \nCLASS A B C M  \n\n| APPLICANT INFORMATION\u003Cbr>LAST NAME:   FIRST NAME:   MIDDLE NAME:   SUFFIX:   MAIDEN NAME:  \u003Cbr>DATE OF BIRTH:\u003Cbr>  —  —  (MM-DD-YYYY)\u003Cbr>SOCIAL SECURITY NUMBER:\u003Cbr>— —\u003Cbr>SEX: MALE   FEMALE   RACE:  \u003Cbr>EYE COLOR:   HAIR COLOR:  \u003Cbr>HEIGHT:   [ft. ](ft.   in. WEIGHT:)[ ](ft.   in. WEIGHT:)[ in. WEIGHT:](ft.   in. WEIGHT:)   lbs.\u003Cbr>UNITED STATES CITIZEN: yes   no   | CONTACT INFORMATION\u003Cbr>HOME PHONE:   OTHER PHONE:   EMAIL:  \u003Cbr>ADDRESS INFORMATION\u003Cbr>RESIDENCE ADDRESS: (in line below)\u003Cbr>CITY:   COUNTY:  \u003Cbr>STATE:   ZIP CODE:   COUNTRY:  \u003Cbr>MAILING ADDRESS\u003Cbr>CITY:   STATE:  \u003Cbr>ZIP CODE:   COUNTRY:   |\n| --- | --- |\n| PLACE OF BIRTH: CITY:   COUNTY:   STATE:   COUNTRY:   FATHER’S LAST NAME:   MOTHER’S MAIDEN NAME:   |  |\n\n\n| REQUIRED INFORMATION FROM ALL APPLICANTS |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n| YES 1.  |  | NO\u003Cbr>|  |  | Do you wish to donate $1.00 to the Blindness Education Screening and Treatment Program? |\n| 2.  |  | |  |  | Do you wish to donate $1.00 to the Glenda Dawson Donate Life – Texas Registry? |\n| 3.  |  | |  |  | Would you like to register as an organ donor? |\n| 4.  |  | |  |  | Do you have a health condition that may impede communication with a peace officer? If yes, please list  \u003Cbr>   (must complete form DL-101) |\n| 5.  |  | |  |  | Would you like to complete a voter registration application form today? You must be eligible.(¿Le gustaria llenar la forma de registro de votante hoy? Tiene que ser elegible.) |\n| 6.  |  | |  |  | Are you a veteran and were you honorably discharged? If yes, what branch of service?   |\n| 7.  |  | |  |  | Do you want a veteran designator on your driver license? (proof of honorable discharge required) |\n| 8.  |  | |  |  | Have you ever had a Texas identification card? Number   When?   |\n| 9.  |  | |  |  | Have you ever had a driver license or instruction permit in Texas? Number   When?   |\n| 10.  |  | |  |  | Have you ever had a license or instruction permit in any other state? List state(s)   Number(s)   When?   |\n| REQUIRED INFORMATION FROM DRIVER LICENSE APPLICANTS |  |  |  |  |  |\n| 11. | YES\u003Cbr>|  | NO\u003Cbr>| DRIVING HISTORY INFORMATION\u003Cbr>Are you enrolled in or have you completed an approved driver education course? |  |\n| 12. | |  | | Is your driver license or driver privilege CURRENTLY or EVER been suspended, revoked, canceled, denied or disqualified in ANY state? Where?   When?   Why?  \u003Cbr>VEHICLE REGISTRATION AND INSURANCE INFORMATION |  |\n| 13. | |  | | Do you own a motor vehicle which is required to be registered (Texas Transportation Code Section 502.002)? |  |\n| 14. | |  | | Do you own a motor vehicle which is required to have liability insurance OR other proof of financial responsibility in compliance with the Motor Vehicle Safety Responsibility Act (Texas Transportation Code Section 601.051)?\u003Cbr>APPLICATION CONTINUED ON BACK |  |\n\nFOR DEPARTMENT USE ONLY  \nDOCUMENT PRESENTED:   DOCUMENT NUMBER:   ISSUING AGENCY:    \nDOCUMENT PRESENTED:   DOCUMENT NUMBER:   ISSUING AGENCY:    \nDOCUMENT PRESENTED:   DOCUMENT NUMBER:   ISSUING AGENCY:    \nDOCUMENT PRESENTED:   DOCUMENT NUMBER:   ISSUING AGENCY:    \nDOCUMENT PRESENTED:   DOCUMENT NUMBER:   ISSUING AGENCY:    \nDRIVER LICENSE APPLICANTS  \nThe answers to questions 1 through 7 below are for the confidential use of the Department  \nYES NO MEDICAL HISTORY QUEST","cbCaidBAN7CrYYJB","https://ap.wps.com/l/cbCaidBAN7CrYYJB","pdf",351513,"English","# Applicant Information\n## Required Information From All Applicants\n## Required Information From Driver License Applicants\n## Medical History Questions","[{\"question\":\"What are the form submission rules and signature requirements?\",\"answer\":\"All information on the application except the signature must be typewritten or printed in black ink, and the signature must be written in black ink. After the form and fee are submitted, no refunds are made.\"},{\"question\":\"What information does the form collect about the applicant?\",\"answer\":\"It collects last name, first name, middle name, suffix and maiden name, date of birth, social security number, sex, race, eye and hair color, height and weight, U.S. citizenship, and full contact and address details, including place of birth and parents’ names.\"},{\"question\":\"What medical history topics are asked for driver license applicants?\",\"answer\":\"Questions cover medical conditions that may affect safe operation, psychiatric disorder diagnoses or treatment, psychiatric hospitalization, seizure history, insulin-treated diabetes, alcohol or drug dependencies and recent abuse, other serious medical conditions within two years, and whether the applicant was referred to the Texas Medical Advisory Board for driver licensing.\"}]","Texas Driver License Application Form - Rev 11/11 | PDF",1789827459]