Has your license ever been suspended or revoked? Yes No . If yes, provide detail(s) below: driver’s State of Date Length of Suspension Reason for Suspension Suspension Have you ever been denied issuance of a license? Yes No . If yes, provide detail(s) below: driver’s Have you ever been involved in a motor vehicle crash? Yes No . If yes, provide detail(s) below: Were you found Date Location of Crash Citation Issued? Injuries to any party? Police Report Made? to be at fault? Have you ever attended a Driver Improvement Course? Yes No . If yes, provide detail(s) below: Date Location of Course Reason for taking the course (court ordered, etc.) Applicant Initials Page 5 of 22 Word Doc - Revised February 2019 4. DRIVING HISTORY (continued)
Has your driver’s license ever been suspended or revoked? Yes No . If yes, provide detail(s) below: Date State of Suspension Length of Suspension Reason for Suspension Have you ever been denied issuance of a driver’s license? Yes No . If yes, provide detail(s) below: Have you ever been involved in a motor vehicle crash? Yes No . If yes, provide detail(s) below: Date Location of Crash Were you found to be at fault? Citation Issued? Injuries to any party? Police Report Made? Have you ever attended a Driver Improvement Course? Yes No . If yes, provide detail(s) below: Date Location of Course Reason for taking the course (court ordered, etc.) Applicant Initials Page 5 of 22 Word Doc - Revised February 2019 4. DRIVING HISTORY (continued)
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