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Affirmation of No Criminal History

If you have no criminal history, complete this form to officially affirm your status in our records. NOTE: This only needs to be completed if you currently have a new or renewal application on file with Occupational Licensing.

Type of Application   This form is tied to your application for a license or registration. Is yours a new application or a renewal?


BASIC INFORMATION
Date of Birth Please select your date of birth.
/ /  
ATTESTATION of NO CRIMINAL HISTORY
Check this box to attest that you have no record of convictions, pending charges, or arrests.
ELECTRONIC SIGNATURE and AFFIRMATION
By entering your name and the last four digits of your Social Security number here, you are signing this form electronically.
Affirmation By clicking the Submit button, I affirm that the above information is true and correct. I understand that fraudulent or falsified information could result in denial of this application pursuant to Section 30.33 of the Texas Administrative Code or revocation of my license pursuant to Section 7.303 of the Texas Water Code.