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Restricted Drivers License Form - General Sessions - Tennessee

Restricted Drivers License Form - General Sessions Form. This is a Tennessee form and can be used in Criminal Court - General Sessions Court Davidson Local County .
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CRIMINAL COURT CLERK'S OFFICE Application for a Restricted Driver's License Were you convicted of DUI? _______________ County/State of Conviction ______________________ Were you convicted of Implied Consent? _____________ Warrant Case # _____________________ Date you went to court _______________________ GENERAL SESSIONS COURT OUT OF COUNTY OFFENDERS MUST HAVE THE FOLLOWING INFORMATION Docket Number: ________________ County/State where you were charged: _________________ Court Date: _______________ Date you were arrested: ____________ Name of Court: __________________ Judge's Name: _____________________________ Personal History Information Last Name First Name Middle Name Home Phone # Home Address City State Zip Code Driver's License Number State where you are licensed Date of Birth Employment Information Job # 1 Job # 2 Employer's Name & Phone # :_____________________________________________________________________________________________________ Employer's Address :_____________________________________________________________________________________________________________ Work Locations :________________________________________________________________________________________________________________ Job Occupation:_________________________________________________________________________________________________________________ Permitted Driving Days :__________________________________________________________________________________________________________ Permitted Driving Hours: __________________________________________________________________________________________________________ Court-Ordered Alcohol Program Address:_____________________________________________________________________________________________ Interlock Monitoring Appointment Address: ___________________________________________________________________________________________ Probation Office Address:_________________________________________________________________________________________________________ Regular Place of Worship: ______________________________Address:______________________________________ Day & Time:__________________ Litter Pickup or CSW:____________________________________________________________Address:_______________________________________ Outpatient Alcohol/Drug Treatment Program:___________________________________________Address:_______________________________________ Authorized to drive employer's vechicles without ignition interlock device, provided proof the employer is aware of the restriction is kept in the vehicle. (All applicants must provide SPECIFIC work hours or judge will not sign; work hrs can't exceed 12 hr time frame) For work hours, please specify A.M. or P.M. You must provide a letter from your employer if total hours per week exceed 50 hours. American LegalNet, Inc. www.FormsWorkFlow.com THIS COURT ORDER IS NOT A DRIVER LICENSE AND WILL NOT BE HONORED AS A DRIVER LICENSE. IF YOU DRIVE OUTSIDE OF TENNESSEE, IT IS SUGGESTED THAT YOU OBTAIN WRITTEN PERMISSION FROM THE APPROPRIATE AUTHORITY IN THAT JURISDICTION. I. INSTRUCTIONS FOR ISSUANCE OF RESTRICTED LICENSE FOR DUI OR DRAG RACING The state statute provides a restricted driver license can be issued under limited circumstances. Driving is permitted ONLY to and from home to place of employment and if required while in the actual performance of duties, or going to and from home to a college or university as a full time student, or court-ordered alcohol or drug treatment, or scheduled litter pickup, or to and from a court-ordered alcohol safety DUI program or scheduled interlock monitoring appointment, or to and from probation office, or to and from driver's regular place of worship. Privilege to drive, other than these restrictions is REVOKED and driving PROHIBITED per state statute, unless Court has authorized license with ignition interlock device and NO geographic restrictions. TO BE ELIGIBLE FOR THIS RESTRICTED DRIVER LICENSE: · Privilege to drive cannot be under revocation/suspension/cancellation for any other reason in Tennessee or any other state. Will be required to meet all requirements to clear any such revocation/suspension/cancellation before issuance of the restricted driver license. · If applying for a restricted license, after a Driving under the Influence conviction, must not have been convicted of a prior Driving under the Influence or Adult Driving while Impaired within ten (10) years of the present violation, or convicted of a prior vehicular homicide as the proximate result of intoxication, aggravated vehicular homicide, or vehicular assault. · If applying for a restricted license, after a Driving under the Influence conviction, cannot have been involved in an accident in which a person was killed, or suffered serious bodily injury, as the approximate result of the Driving under the Influence violation. · If restricted to vehicle(s) with ignition interlock device, such device must be installed on the vehicle before applying for the restricted driver license and must be used while operating the vehicle in order for the restricted license to be valid. · If driving privileges were revoked for two (2) years, must have served one year of the revocation period and will be restricted to operating vehicles with an ignition interlock device ­ again must be installed before applying for the restricted driver license. Go to a Driver Services Center within ten (10) days of the date of this Court Order and present two (2) copies of this Order along with a SR-22 form, or Financial Responsibility Bond, or $60,000 in cash or Corporate Surety Bond; OR, you must establish that one of these is presently on file with the Department of Safety in Nashville at the time of application. (When applying for the SR-22 insurance filing from your agent, you should request that the agent provide you with a copy of the SR-22 form. When you receive your copy, you will know that a filing has been made with the Department of Safety and your copy will be accepted when you apply for your Restricted License). If the Court or statute requires the driver be restricted to vehicles with functioning ignition interlock device, the device must be installed on the vehicle and verified by the Department of Safety. Upon paying the required license fees (the license fee is $65.00 and the application fee is $2.00) a 90-day interim license will be issued. Barring any complication, an original restricted license will be mailed to you within the 90 da
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