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Notification of Criminal Charges or Convictions for Renewals

Renewal Applicants: If you have one or more criminal charges, convictions, or both on your record, complete this electronic form to officially notify us of your status. NOTE: This only needs to be completed if you currently have a renewal application on file with Occupational Licensing. New applicants must complete the downloadable form.

New applicants should not use the electronic form below. Instead, new applicants must complete an electronic or hard copy (paper) version of the Criminal History Notification Form Adobe Acrobat PDF Document and upload it when applying via e-Application. If a new applicant must use a paper application, the hard copy of the Criminal History form must be included with their paper application packet.

For Renewal applicants, if you have multiple arrests or convictions, you can submit the electronic form below as many times as needed to submit all of your information. Alternatively, you can use one of the resources below to acquire your complete criminal history and submit that along with the Criminal History Notification Form Adobe Acrobat PDF Document, making sure to complete the top portion of the form and signing it.

 

All required fields are marked with a red dot.

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 date of birth
/ /  
CONVICTION INFORMATION
Date of Conviction Please select date of conviction
/ /  
Trial Date Please select trial date
/ /  
ARREST INFORMATION
Date Arrested or Charged Please select date arrested or charged.
/ /  
Trial Date Please select trial date
/ /  
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.