(Rev. 1/17/01) CCTR 0500 PETITION FOR JUDICIAL DRIVING PERMIT TO RELIEVE UNDUE HARDSHIP ________________________________________________ __________________________________________ NAME DRIVER’S LICENSE NUMBER __________________________________________________ STREET ADDRESS __________________________________________________ CITY/STATE/ZIP __________________________________________ CASE NUMBER __________________________________________ COUNTY __________________________________________ DATE I do solemnly, sincerely, and truly declare and affirm that: 1. I am a first offender as defined in 625 ILCS 5/11-500 of the Illinois Vehicle Code (see definition below). 2. I have received, or will have received prior to a hearing on this Petition, a current evaluation of my alcohol or other drug use performed by a licensed professional evaluator. 3. I have not been convicted of Reckless Homicide within the previous 5 years. 4. My driver’s license will be valid (except for the Statutory Summary suspension) during the period covered by the Judicial Driving Permit. 5. The undue hardship that would be caused if I do not receive a Judicial Driving Permit is: ________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ (check appropriate item below) q 6. I am presently employed with ____________________________________________________________________ (employer) _______________________________________________________________________________________________ (address) (city/state) (zip) and that I have no other means of commuting to my place of employment, or that I must drive as a condition of employment; that my employer has certified the hours and days of employment and the parameters necessary for driving as a condition of employment and said certification is attached hereto. q 7. I am required to secure alcohol or other medical treatment for myself or a family member and have no alternative means of transportation; that the treating physical/counselor has certified the need of treatment, said certification is attached hereto. q 8. I have been convicted of the following traffic and/or alcohol related offenses on the below listed dates, and have the following pending traffic and/or alcohol related violations: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ __________________________________________ Signature of Petitioner 5/11-500. Definitions § 11-500. Definitions. For the purposes of interpreting Sections 6-206.1 and 6-208.1 of this Code, “first offender” shall mean any person who has not had a previous conviction or court assigned supervision for violation Section 11-501, or a similar provision of a local ordinance, or a conviction in any other state for a violation of driving while under the influence or a similar offense where the cause of action is the same or substantially similar to this Code or any person who has not had a driver’s license suspension for violating Section 11-501.1 within 5 years prior to the date of current offense, except in cases where the driver submitted to chemical testing resulting in an alcohol concentration of 0.08 or more, or any amount of a drug, substance, or compound in such persons blood or urine resulting from the unlawful use or consumption of cannabis listed in the Cannabis Control Act 1 or controlled substance listed in the Illinois Controlled Substance Act 2 and was subsequently found not guilty of violating Section 11-501, or a similar provision of a local ordinance. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Print This Form For your protection and privacy, please press the Clear This Form button after you have printed the form. Clear This Form