Have you ever been convicted of a felony?
if yes, please specify date
Have you ever been convicted, or are any charges pending, for driving while under the influence of alcohol, a narcotic drug, amphetamines or derivatives thereof?
if yes, please specify date
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
if yes, please specify date
Have you ever had a license, permit, or privilege suspended or revoked?
if yes, please specify date
Have you ever been convicted, or are any charges pending, for reckless or careless operation of a motor vehicle?
if yes, please specify date
Have you ever been convicted, or are any charges pending, for possession, sale or use of a narcotic drug, amphetamines, or derivatives thereof?
if yes, please specify date
Have you ever been refused any type of insurance or been denied bonding?
if yes, please specify date
Have you ever been discharged or suspended?
if yes, please specify date
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