If you have had an occupational license revoked, suspended, probated or denied in any state, county or municipality, the
Department must review your disciplinary action history to determine if you are eligible to obtain a license. If you have had
more than one disciplinary action, you must complete a separate form for each one. Provide exact details when
completing this form. Provide information pertaining to occupational licenses only, not driver licenses.
Questions regarding this form may be addressed to the Texas Department of Licensing and Regulation (TDLR)
Enforcement Division at (512) 539-5600. Please mail this form, along with the appropriate application and fee, to the
address above. If you need to email it, please send it to CHQ@tdlr.texas.gov and provide the type of license you are
applying for with TDLR.
1. TYPE OF REQUEST – Write the type of license you are applying for or renewing. (ex: Barber,Cosmetology, Electrician,
Towing, Air Conditioning Technician, etc.)
2. NAME – Write your legal name in the spaces provided. (Last Name, First Name, Middle Name, Suffix) Examples of a
suffix include Jr., Sr., and II. (Mr. is not a suffix.)
3. SOCIAL SECURITY NUMBER – Social Security Number disclosure is required by Section 231.302(c)(1) of the Texas
Family Code 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, visit the Texas Attorney
General website or call (512) 460-6000 or (800) 252-8014.
4. PHONE NUMBER – Write 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.
5. EMAIL ADDRESS – By providing my email address I authorize TDLR to send licensing communications and required
notices to me by electronic mail. I understand that I may revoke this authorization in writing and that I must update my
email address, or I will not receive these notices. I understand that the email address I have provided in this application
will remain confidential except as permitted or required by law.
6. MAILING ADDRESS – Write 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.
7. LICENSE REVOKED, SUSPENDED OR PROBATED – Complete this section if you have had one, or more, occupational
licenses revoked, suspended or probated. Provide the requested information as to each revocation, suspension or
probation. Attach additional pages if necessary.
8. LICENSE DENIED – If you applied for an occupational license and it was denied, complete this section. If you have had
more than one license denial, provide the requested information separately as to each denial. Attach additional pages if
necessary.
9. STATEMENT OF APPLICANT – Carefully read the statement before dating and signing your application.
FAILURE TO FILL OUT THIS FORM ACCURATELY AND COMPLETELY WILL DELAY
THE CONSIDERATION OF YOUR APPLICATION
DISCIPLINARY ACTION QUESTIONNAIRE INSTRUCTIONS
TDLR Form ENF002 rev December 2020
