SECTION II – CRIMINAL HISTORY
A. Submit a signed and dated typed statement containing a following:
1. A list of each felony and each violation of 18 USC § 1033 for which you have been arrested, charged, indicted or convicted,
negotiated a plea agreement or submitted a plea of nolo contendre, regardless of the outcome of any resulting case. For each
case include:
a. The events (including dates, locations, and your actions) that led to each arrest, charge, indictment, conviction or plea
agreement;
b. The nature of the offense(s) for which you were charged (for example, ‘burglary’) and the classification of each offense (for
example, ‘class 2 felony’);
c. The identity and location of the court or similar body that adjudicated the case and the case number;
d. For each offense of which you were found or plead guilty or nolo contendre,
i. the date the judgment or plea was entered,
ii. the type of judgment or plea (whether you were found guilty or not guilty, plead guilty or nolo contendre, etc.)
concerning each charge,
iii. the nature and classification of each offense of which you were found or plead guilty or nolo contendre; and
iv. if applicable, whether the conviction was pardoned, expunged, set aside, or is currently under appeal.
2. The term of incarceration to which you were sentenced, the range of dates during which you were incarcerated; and an
explanation of any differences between the length of your sentence and time served.
3. The term of parole/probation to which you were sentenced, the range of dates during which you were on parole/probation and
whether you are currently on parole/probation. If you are currently on parole/probation,
a. The date your parole/probation is currently scheduled to end;
b. Limitations on your activities or requirements you must fulfill as conditions of your parole/probation;
c. The name and telephone number of the person supervising your parole/probation.
4. The amounts of restitution imposed in the sentence, the amounts you paid and the amounts you owe;
5. The amounts of fines, penalties and costs imposed in the sentence, the amounts you paid and the amounts you owe; and
6. Whether your civil and political rights have been restored.
B. Submit a certified copy of each indictment, criminal complaint, or docket sheet or other initiating documents showing the charge(s). If a
certified copy is not available, include a letter from the clerk of the court of jurisdiction that explains why the document is not available.
C. Submit a certified copy of each court order of judgment and sentence for the conviction, including court certification that you completed
and performed all court-imposed conditions/requirements. If a certified copy is not available, include a letter from the clerk of the court
of jurisdiction that explains why the document is not available.
NOTE: An application without all required attachments or with incomplete attachments will be returned to the applicant.