Get TX DL-14A 2020-2024

Sss. gov/FactSheets/FSaltsvc.pdf. DL-14A Rev. 6/14 Answers to 1 through 7 below are for the confidential use of the Department. X Signature of Applicant Date Texas law requires the Texas Department of Public Safety must provide every minor applicant under age 18 and cosigner for a driver license in Texas educational information concerning state laws relating to driving while intoxicated driving by a minor with alcohol in the minor s system and the implied consent law. A Do you want a Veteran designator on your driver license or identification card proof of Honorable discharge required acceptable documents are DD214/5 NGB22 VA disability letter proof of service/verification of honorable service card b Are you a 60 disabled Veteran receiving compensation and want to waive the application fee see 8a for documents required In the event of injury or death would you like to provide two 2 emergency contacts If yes please list a Name b Name Telephone Number Address Have you ever had a Texas identification card Number YES NO When DRIVING HISTORY INFORMATION Are you enrolled in or have you completed an approved driver education course Is your driver license or driver privilege CURRENTLY or EVER been suspended revoked canceled denied or disqualified in ANY state Where Why VEHICLE REGISTRATION AND INSURANCE INFORMATION Do you own a motor vehicle which is required to be registered Texas Transportation Code Section 502. 040 Motor Vehicle Safety Responsibility Act Texas Transportation Code Section 601. 051 UNITED STATES SELECTIVE SERVICE Any male United States citizen or immigrant who is at least 18 years of age but less than 26 years of age submitting this application consents to registration with the United States Selective Service System. You must be registered to qualify for federal student aid to include Pell grant job training federal employment and citizenship if an immigrant. Wanting to register to vote I authorize the Department of Public Safety to transfer this information to the Texas Secretary of State. Do you wish to donate 1. 00 to the Blindness Education Screening and Treatment Program Would you like to register as an organ donor Do you want to support Texas Veterans If yes please indicate your donation amount Do you have a health condition that may impede communication with a peace officer If yes please list physician must complete form DL-101 prior to the issuance of a DL/ID. a Do you want a Veteran designator on your driver license or identification card proof of Honorable discharge required acceptable documents are DD214/5 NGB22 VA disability letter proof of service/verification of honorable service card b Are you a 60 disabled Veteran receiving compensation and want to waive the application fee see 8a for documents required In the event of injury or death would you like to provide two 2 emergency contacts If yes please list a Name b Name Telephone Number Address Have you ever had a Texas identification card Number YES NO When DRIVING HISTORY INFORMATION Are you enrolled in or have you completed an approved driver education course Is your driver license or driver privilege CURRENTLY or EVER been suspended revoked canceled denied or disqualified in ANY state Where Why VEHICLE REGISTRATION AND INSURANCE INFORMATION Do you own a motor vehicle which is required to be registered Texas Transportation Code Section 502. MEDICAL HISTORY QUESTIONS Do you currently have or have you ever been diagnosed with or treated for any medical condition that may affect your ability to safely operate a motor vehicle EXAMPLES including but not limited to Diagnosis or treatment for heart trouble stroke hemorrhage or clots high blood pressure emphysema within past two years progressive eye disorder or injury i.e. glaucoma macular degeneration etc. loss of normal use of hand arm foot or leg blackouts seizures loss of consciousness or body control within the past two years difficulty turning head from side to side loss of muscular control stiff joints or neck inadequate hand/eye coordination medical condition that affects your judgment dizziness or balance problems missing limbs Please explain and identify medical condition Within the past two years have you been diagnosed with been hospitalized for or are you now receiving treatment for a psychiatric disorder Do you have diabetes requiring treatment by Do you have any alcohol or drug dependencies that may affect your ability to safely operate a motor vehicle or have you had any episodes of alcohol or drug abuse within the past two years Have you EVER been referred to the Texas Medical Advisory Board for Driver Licensing NOTICE The information on this application is required by the Texas Driver License Act Texas Transportation Code Chapter 521. Failure to provide the information is cause for refusal to issue a driver license or identification card and in some cases cancellation or withdrawal of driving privileges. False information could also lead to criminal charges with penalties of a fine up to 4 000. 00 and/or jail. DO NOT SIGN BELOW UNTIL INSTRUCTED TO DO SO BY NOTARY PUBLIC OR CERTIFICATION EMPLOYEE. I do solemnly swear affirm or certify that I am the person named herein and that the statements on this application are true and correct. Applications held only 90 days. DPS CANNOT REFUND PAYMENT ONCE APPLICATION IS SUBMITTED. APPLICATION for DRIVER LICENSE COMMERCIAL DRIVER LICENSE CDL IDENTIFICATION CARD Class Circle A B C M HOME PHONE FIRST NAME OTHER PHONE MIDDLE NAME EMAIL SUFFIX ADDRESS INFORMATION MAIDEN NAME DATE OF BIRTH mm/dd/yyyy EYE COLOR LEARNER LICENSE CONTACT INFORMATION LAST NAME SEX Circle One ASSIGNED NON-RESIDENT COMMERCIAL DRIVER LICENSE SSN FOR DEPARTMENT USE ONLY RESTRICTIONS/ENDORSEMENTS MALE RACE / ETHNICITY RESIDENCE ADDRESS CITY FEMALE ZIP CODE HAIR COLOR MAILING ADDRESS I American Indian /Alaska Native A Asian / Pacific Islander B Black H Hispanic O Other W White HEIGHT ft. PLACE OF BIRTH CITY in. WEIGHT lbs. FATHER S LAST NAME COUNTY STATE MOTHER S MAIDEN NAME REQUIRED INFORMATION FROM ALL APPLICANTS YES NO Are you a citizen of the United States If you are a US citizen would you like to register to vote If registered would you like to update your voter information By providing my electronic signature I understand the personal information on my application form and my electronic signature will be used for submitting my voter s registration application to the Texas Secretary of State s office. Wanting to register to vote I authorize the Department of Public Safety to transfer this information to the Texas Secretary of State. PLACE OF BIRTH CITY in. WEIGHT lbs. FATHER S LAST NAME COUNTY STATE MOTHER S MAIDEN NAME REQUIRED INFORMATION FROM ALL APPLICANTS YES NO Are you a citizen of the United States If you are a US citizen would you like to register to vote If registered would you like to update your voter information By providing my electronic signature I understand the personal information on my application form and my electronic signature will be used for submitting my voter s registration application to the Texas Secretary of State s office. Wanting to register to vote I authorize the Department of Public Safety to transfer this information to the Texas Secretary of State. Do you wish to donate 1. 00 to the Blindness Education Screening and Treatment Program Would you like to register as an organ donor Do you want to support Texas Veterans If yes please indicate your donation amount Do you have a health condition that may impede communication with a peace officer If yes please list physician must complete form DL-101 prior to the issuance of a DL/ID. APPLICATION FOR TEXAS DRIVER LICENSE OR IDENTIFICATION CARD NOTICE All information on this application must be in INK. Applications held only 90 days. DPS CANNOT REFUND PAYMENT ONCE APPLICATION IS SUBMITTED. APPLICATION for DRIVER LICENSE COMMERCIAL DRIVER LICENSE CDL IDENTIFICATION CARD Class Circle A B C M HOME PHONE FIRST NAME OTHER PHONE MIDDLE NAME EMAIL SUFFIX ADDRESS INFORMATION MAIDEN NAME DATE OF BIRTH mm/dd/yyyy EYE COLOR LEARNER LICENSE CONTACT INFORMATION LAST NAME SEX Circle One ASSIGNED NON-RESIDENT COMMERCIAL DRIVER LICENSE SSN FOR DEPARTMENT USE ONLY RESTRICTIONS/ENDORSEMENTS MALE RACE / ETHNICITY RESIDENCE ADDRESS CITY FEMALE ZIP CODE HAIR COLOR MAILING ADDRESS I American Indian /Alaska Native A Asian / Pacific Islander B Black H Hispanic O Other W White HEIGHT ft. PLACE OF BIRTH CITY in. WEIGHT lbs. FATHER S LAST NAME COUNTY STATE MOTHER S MAIDEN NAME REQUIRED INFORMATION FROM ALL APPLICANTS YES NO Are you a citizen of the United States If you are a US citizen would you like to register to vote If registered would you like to update your voter information By providing my electronic signature I understand the personal information on my application form and my electronic signature will be used for submitting my voter s registration application to the Texas Secretary of State s office.