Fillable CRIMINAL HISTORY QUESTIONNAIRE INSTRUCTIONS 1. TYPE OF REQUEST (Texas Real Estate Contracts)

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CRIMINAL HISTORY QUESTIONNAIRE INSTRUCTIONS 1. TYPE OF REQUEST (Texas Real Estate Contracts)

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The CRIMINAL HISTORY QUESTIONNAIRE INSTRUCTIONS 1. TYPE OF REQUEST (Texas Real Estate Contracts) form is 3 pages long and contains:

  • 1 signature
  • 8 check-boxes
  • 19 other fields

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File type: PDF

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The Texas Real Estate Commission (TREC) is an agency that governs real estate practices in the state of Texas USA. I its headquarters are located in Ausin Texas at 1700 North Congress.

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1. TYPE OF REQUEST – Check the box to indicate whether you are applying for a new license or
renewing a license.
2. TYPE OF LICENSE – Provide the type of license you are applying for or renewing. (ex: Barber,
Cosmetology, Electrician, Towing, Air Conditioning Technician, etc.)
3. NAME – Write your full legal name in the spaces provided. (Last, First, Middle Name)
4. SOCIAL SECURITY NUMBER (SSN) – Social Security number disclosure is required by Section
231.302(1) of the Texas Family Code in order to obtain a license. Your social security number is subject
to disclosure to an agency authorized to assist in the collection of child support payments. For more
information regarding child support payments, contact the Texas Attorney General at:
www.texasattorneygeneral.gov/cs or call (512) 460-6000 or (800) 252-8014.
5. MAILING ADDRESS – Provide your current mailing address. This is the address where we will send
you mail. This address can be a post office box. You can add the zip plus-4 to help the postal service
deliver mail more efficiently and accurately.
6. PHONE NUMBER – Provide a telephone number, including the area code, where we can reach you
during the day. This may be your office phone number where we can leave a message.
7. DATE OF BIRTH – Provide your birthdate.
8. EMAIL ADDRESS – Provide your email address. TDLR will only use your email address for
the purpose of communicating with you electronically in a manner which protects your email
address from disclosure under the Public Information Act.
9. COUNTY AND STATE OF CONVICTION OR DEFERRED ADJUDICATION – ex: Travis, TX; Baxter,
AR; Fresno, CA.
10. COURT – Give the name of the court your case was held. (ex: 300th District Court, Superior Court,
Federal Court)
11. DATE CRIME COMMITTED – Give the date you committed the crime.
12. DATE OF THE CONVICTION OR DEFERRED ADJUDICATION – Give the date you were convicted or
received a deferred adjudication.
13. EXACT CRIME YOU WERE CONVICTED OF OR RECEIVED A DEFERRED ADJUDICATION FOR –
Give the official description of the offense shown on your court records.
14. WHAT EXACTLY DID YOU DO (CRIME) AND WHY – Give a detailed description of your actions and
why you made those decisions, do not simply restate the name of your offense. (If you need more
space to write, attach additional sheets)
15. SENTENCE OR ACTION IMPOSED BY THE COURT – (ex: six months in Travis County Jail, deferred
adjudication, probation, etc.)
16. RENEWALS – If you are renewing your license, did the conviction or deferred adjudication you
described in item 11 occur since your license was last issued? Place a check in the box for No or Yes.
17. PAROLE – If you are not on parole please check No. If you answered Yes list your reporting officer’s
name and phone number.
CRIMINAL HISTORY QUESTIONNAIRE INSTRUCTIONS
18. PROBATION – If you are not on probation please check No. If you answered Yes list your reporting
officer’s name and phone number.
19. DATE AND SIGNATURE OF APPLICANT
– Carefully read the statement before signing and dating
this criminal history questionnaire.
SEND YOUR COMPLETED APPLICATION AND REQUIRED DOCUMENTS TO:
Texas Department of Licensing and Regulation
P.O. Box 12157
Austin, TX 78711-2157
Documents submitted with your application will not be returned. Keep a copy of your completed application,
all attachments, and you check or money order. Do not send cash.
For additional information and questions, please visit the Texas Department of Licensing & Regulation
website at https://www.tdlr.texas.gov or reach Customer Service via webform where you can submit your
request for assistance and include attachments as needed at https://www.tdlr.texas.gov/help. Customer
Service can also be reached at (800) 803-9202 [in state only], (512) 463-6599, Relay Texas-TDD: (800)
735-2989 or Fax: (512) 463-9468. Customer Service Representatives are available Monday through Friday
7:00 a.m. until 6:00 p.m. Central Time (excluding holidays).
TDLR Form LIC002 rev January 2020
1. Type of Request:
4. SSN:
(See instruction sheet for disclosure Information)
5. Address:
Number, Street Name, Suite Number/Apartment Number City State Zip Code
6. Phone No:
(Area Code) Phone Number
7. DOB:
9. County and State of conviction or deferred adjudication:
(ex: Travis, TX)
10. Court:
11. Date crime committed:
12. Date of conviction or deferred adjudication:
15. Sentence or action imposed by the court: (ex: six months in Travis County Jail)
14. Give a detailed description of your actions and why you made those decisions; do not simply restate the name of your offense:
(if you need more space to write, attached additional sheets)
16. For renewals, did this conviction or deferred adjudication occur since last license was issued:
17. Are you currently on parole?
(Area Code) Phone Number
18. Are you currently on probation?
Probation Officer’s Name
2. Type of License:
ex: Barber, Cosmetologist, Electrician, Towing, etc.
19. Date and Signature:
By signing below, I affirm I am the applicant completing this form and understand that if I fail to provide full and
accurate information, the issuance or renewal of my license could be delayed or denied.
Date Signed
Signature of Applicant
3. Name:
TDLR Form LIC002 rev January 2020
CRIMINAL HISTORY QUESTIONNAIRE
(ex: 300th Dist. Ct. or Fed. Ct.)
13. Exact crime you were convicted of or received a deferred adjudication.
Last, First, Middle, Suffix (Jr, Sr, III)
(Area Code) Phone Number
8. Email Address:
Month/Day/Year
Month/Day/Year Month/Day/Year
Renewal
New
Yes
Yes (if yes, list your reporting officer's name and phone number below)
No
No
Yes (if yes, list your reporting officer's name and phone number below)No
See instruction sheet for disclosure information
Parole Officer’s Name
TDLR must review your criminal history to determine if you are eligible to receive or renew a license. You must complete this form if
you have ever been convicted of a
felony or misdemeanor (other than a minor traffic violation) or pleaded guilty or no contest “nolo
contendere” (resulting in a deferred adjudication) to any in-state, out of state or federal criminal offense. Provide specific details,
attaching a separate questionnaire form for each crime.
Our review may take many weeks or months to complete. Questions regarding this form may be addressed to the TDLR’s
Enforcement Division at (512) 539-5600. Please mail this form, along with the appropriate application and fee, to the address above,
or if you choose to email it, please send it to CHQ@tdlr.texas.gov.
Your application will not be processed until this form, the application and payment are received.
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CRIMINAL HISTORY QUESTIONNAIRE INSTRUCTIONS 1. TYPE OF REQUEST (Texas Real Estate Contracts)

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Completed 10 October 2020

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