Are you a Professional License Holder? 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Last Name, First Name, and Middle Name in the designated fields. This ensures accurate identification.
3. Fill in your Date of Birth, Address, City, State, and Zip Code to provide your current residence information.
4. Input your Home and Cell Telephone numbers along with your Email address for communication purposes.
5. List all DBPR licenses you hold under the Profession(s) section. Be thorough to avoid any discrepancies.
6. Enter your Professional license number(s) in the provided fields. Ensure accuracy as this is crucial for processing.
7. Respond to questions regarding any guilty pleas or convictions by checking 'Yes' or 'No'.
8. If applicable, provide detailed information about each crime including court name, address, case number, date of plea or conviction, and name of crime.
9. Finally, sign and date the document before submitting it through our platform for processing.

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