Submit the completed form along with required documents to the Texas Department of Licensing & Regulation, P.O. Box 12157, Austin, TX 78711-2157. You can also submit via the TDLR webform. For assistance, contact TDLR Customer Service Representatives at (800) 803-9202 or (512) 463-6599. Avoid sending cash and keep copies for your records. Ensure all fields are accurately filled to prevent any delays.

For the years 2024 and 2025, ensure to check the specific requirements and deadlines for license application and renewal with the Texas Department of Licensing & Regulation. Generally, it is advisable to submit your forms well before the expiration or due date to avoid any delays.

The purpose of the Texas Department of Licensing & Regulation Criminal History Questionnaire is to collect detailed information about an applicant's criminal history to determine their eligibility for obtaining or renewing a license. This form helps TDLR ensure that licensed professionals meet the necessary legal and ethical standards required for public safety and service quality. By providing accurate and complete information, applicants help the department make informed decisions regarding their licensure status. Additionally, the form facilitates a thorough review of any past convictions, ensuring that only qualified and responsible individuals receive or maintain their professional licenses. Adhering to the reporting requirements and submitting this questionnaire helps streamline the licensing process and reduces the risk of potential legal or regulatory issues. Overall, the Criminal History Questionnaire is a critical component in maintaining the integrity and credibility of licensed professionals within the state of Texas.

• 1. Type of Request: Indicates if the request is for a new license or renewal.
• 2. Type of License: Specifies the type of professional license being applied for.
• 3. Name: Full legal name of the applicant.
• 4. SSN: Social Security Number for identification purposes.
• 5. Address: Current mailing address of the applicant.
• 6. Phone No: Daytime contact phone number.
• 7. DOB: Date of Birth of the applicant.
• 8. Email Address: Applicant's email for electronic communication.
• 9. County and State of conviction or deferred adjudication: Jurisdiction where the crime occurred.
• 10. Court: Name of the court where the case was held.
• 11. Date crime committed: Date when the crime was committed.
• 12. Date of conviction or deferred adjudication: Date when the applicant was convicted or received deferred adjudication.
• 13. Exact crime: Specific offense the applicant was convicted of.
• 14. Detailed description: Explanation of the applicant's actions and reasons.
• 15. Sentence or action imposed: Details of the court's decision and penalties.
• 16. Parole: Information regarding current parole status and officer details.
• 17. Probation: Details about any current probation status and officer details.
• 18. Date and Signature: Applicant's signature and date confirming the accuracy of the provided information.

Failure to submit the form may result in denial or delay of your license application or renewal.

• Denial of License: Your license application may be denied if the form is not submitted.
• Delay in Licensing: Without the required documentation, there could be significant delays in processing your application.

• 1. New License Application: Use this form when applying for your first professional license with TDLR.
• 2. License Renewal: Use this form when renewing an existing professional license with TDLR.
• 3. Criminal History Disclosure: Use this form to disclose any criminal history that may affect your eligibility for licensure.