New Drivers Application

Please identify and describe yourself: First Name Last Name Middle Initial Date of Birth Sex Male Female Height Weight Social Security Number   Hair Color Blonde Brown Black Red Gray White Eye Color Blue Brown Black Green Gray Violet Please provide the following contact information: Street Address Address (cont.) City State/Province Zip/Postal Code Country Work Phone Home Phone   FAX E-mail URL Do you possess a valid Florida drivers license?   Yes No Are you a citizen of the United States or an alien admitted for permanent residence who has otherwise been granted employment authorization by the United States Immigration and Naturalization Service?   Yes No Do you Exhibit proficiency with the English language so as to be able to comprehend and interpret traffic signs; issue written receipts to passengers; and obey lawful orders of police and others in lawful authority?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for violent felony?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for sexual offences?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for aggravated child abuse?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for the violation of felony domestic violence?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for the violation of stalking?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for the violation of grand theft?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for the violation of dealing in stolen property?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for the violation of criminal solicitation to commit any of the above?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for the violation of criminal attempt to commit any of the above?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for the violation for any felony in the commission of which a motor vehicle was used?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for the violation of perjury or false swearing in mailing any statement under oath in connection with the application for a driver's permit?   Yes No Have you been convicted, plead nolo contendere, plead guilty, been found guilty, adjudication withheld, or been on probation or parole, for the violation of unlawful possession, sale or distribution of any controlled substance?   Yes No Have you received three (3) or more citations for a moving traffic violation in a twelve (12) month period prior to the date of this application?   Yes No Have you been convicted, placed on probation or parole, plead nolo contendere, plead guilty, or found guilty of a misdemeanor offense of driving a motor vehicle while under the influence of drugs OR intoxicating beverages and Florida Statute, Chapter 893, for a period of three (3) years prior to this application for a driver's permit?   Yes No Enter your Drivers License Number in the space provided below.