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The Law Office of Robert A. Haedge
Phone: 512-540-1673
Fax: 512-582-8550
Email: robert@haedgelaw.com
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The Law Office of Robert A. Haedge
Home
Practice Areas
Criminal Defense
Family Law
Probate
Estate Planning
Expunctions and Nondisclosures
Suspended/Revoked Driver's Licenses
Forms
Blog
Contact
Contact Information
Contact Us
Client Information
Payment Portal
OCCUPATIONAL DRIVER’S LICENSE QUESTIONNAIRE
About You
First Name
*
Middle Name
Last Name
*
Suffix
n/a
Jr.
Sr.
III
Date of Birth
MM
DD
YYYY
Email Address
Phone Number
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Last Four Digits of Social Security Number
Date Driver's License Was Suspended
MM
DD
YYYY
Did you receive an Order of Disqualification from the Texas Department of Public Safety?
*
Yes
No
If not, how did you learn of the suspension?
Was the suspension because of physical or mental disability or impairment?
Yes
No
Have you had a prior suspension arising from an alcohol-related or drug-related enforcement contact in the five (5) years preceding the date of this arrest?
Yes
No
Have you ever been issued an occupational driver’s license?
Yes
No
If so, have you been issued, in the last ten (10) years, more than one occupational license after a conviction under the laws of this state?
Yes
No
Do you have a valid policy of automobile liability insurance?
Yes
No
Do you have an essential need to operate a motor vehicle in the performance of your occupation?
Yes
No
Employment Information
Title
Name of Employer/Company
Employer/Company Address
Kind of Services Employer/Company Performs
Typical Work Schedule
Describe a typical day
Days of the Week
Hours of the Day
Is public transportation available to go to and return from your employment at the times stated?
Yes
No
Can you make arrangements for a carpool or to have a member of your family drive you to and from work?
Yes
No
Can you support yourself and your family without working?
Yes
No
Do you also possess an essential need to drive to and from the grocery store, religious services, and other such locations to perform crucial family obligations?
Yes
No
Are there other places that you absolutely need to be able to drive to?
Yes
No
What are they?
We are going to request that you be granted driving privileges for as many as twelve (12) hours each day. This is merely a request. There is no guarantee that it will be granted. What times of day would you prefer? We can split the time up so that you can drive early in the morning and late in the evening (e.g. 7 a.m. to 11 a.m. and 1 p.m. to 9 p.m.). Otherwise, we could request one large block of time (e.g. 8 a.m. to 8 p.m.). What would you prefer?
Thank you!