You are required to answer the following questions, to provide sufficient information to complete a full background check.
Failure to answer any question will result in your application being denied as incomplete. Making a false statement in this
application may result in prosecution for a misdemeanor and will result in an automatic denial of your application
True False I am at least 21 years of age.
True False Not applicable I have been discharged from the jurisdiction of the juvenile court for more
than four years, if while I was a minor, I was found to be within the jurisdiction of the juvenile court for
having committed an act which, if committed by an adult, would constitute a felony or a misdemeanor
involving violence, as defined in ORS 166.470.
True False I have NEVER been convicted of a felony. This includes being found guilty of a felony by
reason of insanity under ORS 161.295, in the State of Oregon or elsewhere. If false, were you granted
relief from the firearms prohibition?
What State and Court: ____________ When: _____________
True False I have NOT been convicted of a misdemeanor within the last four years from the date of this
application. This includes being found guilty of a misdemeanor by reason of insanity under ORS 161.295
in the State of Oregon or elsewhere.
True False There are no outstanding warrants for my arrest AND I am not free on any form of pre- trial
release including diversion. (DUII)
True False I have NOT been committed to the Mental Health and Developmental Disabilities Services
Division under ORS 426.130, nor have I been found mentally ill and been prohibited from possessing a
firearm because of mental illness. For those previous criminal or mental health conditions that do apply
to me, I have been granted relief from the disability under ORS 166.274 or 18 U.S.C.925(c). Proof of
relief must be attached to this application.
True False I am not presently subject to an order under ORS 426.133 prohibiting me from purchasing or
possessing a firearm.
True False I have completed a handgun safety class and I meet the requirements of ORS
166.291(1)(B)(f) (A) to (G) of competency with a handgun; New applicants must bring documentation
to the appointment indicating that they have completed a handgun safety class. Any of the following are
acceptable; Please see page 5 of this application for additional information.
• Handgun Safety course certificate including the NRA instructors Name and NRA ID number.
• A Hunter Safety class certificate, with documentation indicating handgun safety was a component of
• A handgun safety class taught by law enforcement or a community college utilizing NRA instructors.
• Evidence of equivalent experience with a handgun through participation in organized shooting
competition, security guard, investigators, reserve law enforcement officers or military service
training. Supporting documents can include a score card, training certificate, DD214 or military
I understand I will be fingerprinted (new applicants and transfers) and photographed (all) applicants.
1.) Have you ever been dishonorably discharged from the United States Armed Forces? Yes No
If so, When?
Have you ever been convicted of an offense (including a violation or infraction) involving controlled substances? A
controlled substance is defined under ORS 475.005(6). Examples include but are not limited to marijuana, ecstasy,
heroin, cocaine, LSD, peyote, or methamphetamine. (Alcohol is not a controlled substance.)
If so, When and where?