NUECES COUNTY COURTHOUSE |
Receipt # |
APPLICATION FOR ANNUAL SECURITY ID CARD |
NC Card # |
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Date |
1.Name of Applicant
2.Home Address
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City |
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State |
Zip Code |
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3. |
Telephone |
Home |
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Office |
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Cell |
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Fax |
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4.Office Address:
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City |
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State |
Zip Code |
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5. |
Date of Birth |
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Driver License # |
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(Present valid picture ID) |
6. |
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Sponsoring Attorney or Business Name
7.TX Bar Card Number of Applicant or Sponsor
8.Have you ever been convicted of or placed on probation for a Felony or Crime involving moral turpitude? (Subject to Verification by Criminal Background Check)
9.If yes, provide the Cause Number, County, Offense, Disposition, and Date (plus and Explanation)
I UNDERSTAND THAT AN APPLICATION MUST BE SUBMITTED FOR EACH PERSON RECEIVING A SECURITY ID CARD, AND THAT IF I SPONSOR AN EMPLOYEE, THEY ARE SUBJECT TO CRIMINAL BACKGROUND CHECK AND SUCH REQUEST MAY BE DENIED, AND I AM OBLIGATED TO CANCEL THE CARD IF THE EMPLOYEE LEAVES THIS EMPLOYMENT. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE COUNTY JUDGE’S OFFICE OF ANY OTHER CHANGES IN THE INFORMATION PROVIDED ABOVE AND THIS CARD MAY BE REVOKED AT ANY TIME WITHOUT NOTICE. THE ANNUAL FEE OF $25.00 PER CARD, AND A COPY OF MY DRIVER’S LICENSE AND BAR CARD ARE ATTACHED.
APPLICANT SIGNATURE
APPLICANT SPONSOR (if any)
SUBSCRIBED AND SWORN TO ON THIS |
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DAY OF |
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, 2012 |
NOTARY PUBLIC, STATE OF TEXAS