Application For Driver Permit - Fort Worth
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1
2Application for Driver Permit
____Taxicabs ____Shuttles ____Limousines ____Horse-Drawn Carriages ____Pedicabs
City 0f Fort Worth Office Use Only
( ) NEW
( ) RENEWAL
Received ____/____/____ by: _________ Unqualified ____/____/____ by: _________ Approved ____/____/____ by: __________________
INA Expires ____/____/____ Reason: ____________________________________________ Issued____/____/____ by: _____________________
Paid $______________ Receipt # __________________ Permit Number _____________________________Expiration Date____/____/____
Hold For Reason_______________________________________________________________________________ Test Score _________________
ANY FALSE OR MISLEADING INFORMATION ENTERED ON THIS APPLICATION FORM OR ANY OF ITS ATTACHMENTS WILL BE
CAUSE FOR DENIAL OF THE APPLICATION, OR REVOCATION OF THE PERMIT, IF DISCOVERED AFTER ISSUANCE. THE FEE
SUBMITTED WITH THIS APPLICATION IS NON-REFUNDABLE. PERMITS ARE NON-TRRANSFERABLE
Company Driving For: ______________________________________________________________________________
Name _______________________________________________Date of Birth ____/____/____ Age _______________
Color
Color
Race ___________ Sex __________ Height __________ Weight ___________Eyes _________ Hair __________
TX Driver’s License No.___________________ Class____ Expires ____/____/____ Restrictions__________
Social Security No.________________________ Place of Birth_________________________________________
Current Address__________________________________________________________Phone___________________
City__________________________________________Zip Code_______________________
Places of Residence (past three years):___________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Answer the following:
1. Are you a citizen or legal resident of the U.S.?
( ) Yes
( ) No
2. Are you authorized to work full time in the U.S.?
( ) Yes
( ) No
3. Can you speak and read the English language?
( ) Yes
( ) No
4. Have you ever applied for a City of Fort Worth driver’s permit?
( ) Yes
( ) No
5. Have you ever had a City of Fort Worth driver’s permit?
( ) Yes
( ) No
6. Have you ever had a D/FW Airport driver permit revoked?
( ) Yes
( ) No
7. Do you have any physical or mental disease or disability?
( ) Yes
( ) No
8. Are you under indictment now, or in the last 7 years, have you been
convicted or released from confinement imposed for conviction for a
crime involving murder, kidnapping, theft, burglary, robbery, prostitution,
public lewdness, a sexual offense, fraud, a drug related offense or DWI?
( ) Yes
( ) No
9. Has your State Driver’s License been suspended in the past 3 years?
( ) Yes
( ) No
10. Are there any charges pending or warrants outstanding against you? ( ) Yes
( ) No
11. Have you been involved in any accidents in the past 3 years, when
you were the driver of the vehicle? If so, list on the back of this form.
( ) Yes
( ) No
12. Are you addicted to the use of alcohol or narcotics?
( ) Yes
( ) No
13. Are you well trained and capable of operating a horse-drawn
vehicle? (if applicable)
( ) Yes
( ) No
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