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Begin with Part I, 'Applicant's Certification.' Here, you must acknowledge the restrictions of the temporary license and provide your signature and date.
In Part II, 'Applicant's Information,' fill in your full name, address (not a PO Box), date of birth, and telephone number. Clearly explain why you need the temporary restricted license.
If employed, complete Part III with your employer's information including their name, business address, and type of work performed. Ensure the employer signs and dates this section.
For self-employed individuals, fill out Part IV with your business details. If applicable, provide school information in Part V along with a signature from a school administrator.
If participating in the 24/7 Sobriety Program, complete Part VI by confirming your participation and signing where required.
Finally, if updating any information, use Part VIII to check the appropriate boxes and provide updated details as necessary.
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