Criminal History Review

 

In order to continue the application process, please answer the following questions regarding criminal history.

Applicant Name:
{{full_name}}

Have you ever been convicted of, pled guilty, no contest or nolo contendere, to a Felony or Misdemeanor anywhere (or to an indictable offense in New Jersey)?*

* Do not report any conviction that has been sealed, expunged, statutorily eradicated, annulled, impounded, erased, dismissed under a first offender’s law, pardoned by the Governor or which state law allows you to lawfully deny as set forth below. You are also not required to disclose violations, infractions, or petty misdemeanors or summary offenses. Please also read all the state/local instructions below before answering.

X Yes   X No

 

Note: Convictions will not necessarily result in disqualification from employment. This information will only be used for job-related purposes consistent with applicable law and is only relevant in determining whether the conviction is related to the job for which you are applying. Failure to honestly answer these questions will result in discontinued consideration of the application or termination of employment.

State/Local Instructions:

California applicants/residents: You need not disclose any referral to, and participation in, any pre-trial or post-trial diversion program, or any misdemeanor conviction for which probation had been successfully completed and discharged. Do not list any marijuana-related convictions over two years old, or felony marijuana convictions under California Health and Safety Code Section 11360 (c) which occurred prior to 1976.

San Francisco, CA applicants/residents: You should not disclose: (1) any arrest not leading to conviction; (2) participation in or completion of a diversion or a deferral of judgment program; (3) any conviction that has been judicially dismissed, expunged, voided, invalidated, or otherwise rendered inoperative, by way of example, under California Penal Code sections 1203.4, 1203.4a, or 1203.41; (4) any conviction or other determination or adjudication in the juvenile justice system, or information regarding a matter considered in or processed through the juvenile justice system; (5) any conviction where the date of sentence is more than seven years ago; or (6) any offense other than a felony or misdemeanor, such as an infraction, except for infractions relating to your driving record if driving is required for the position at issue.

Connecticut applicants/residents: You should not disclose any arrest, criminal charge, or conviction record that has been erased pursuant to sections 46b-146, 54-76o or 54-142a of the Connecticut General Statues. Records subject to erasure under these sections are records pertaining to a finding of delinquency or that a child was a member of a family with service needs, an adjudication as a youthful offender, a criminal charge that was dismissed or nolled, or a criminal charge for which the person was found not guilty or received an absolute pardoned conviction. Any person whose records were erased within the meaning of these three sections may consider such events to have never occurred and may so swear under oath.

Kentucky applicants/residents: You should not disclose any misdemeanor conviction where the date of conviction was more than five years ago.

Massachusetts employees/residents: An applicant for employment with a sealed record on file with the commissioner of probation may answer “no” to the above with respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions. In addition, any applicant for employment may answer “no” to the above with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution. You may exclude information regarding first convictions for the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affray, or disturbance of the peace, or a conviction for any misdemeanor where the conviction occurred or any prison sentence ended five or more years ago whichever date is later, unless you have been convicted of another offense within the last 5 years.

Washington applicants/residents: You may exclude convictions that occurred over ten years ago.

If you answered “Yes” to the above question, please list all Felony or Misdemeanor convictions, including any driving related criminal convictions, and complete the information below, consistent with any state or local law limitations.
 
Date of Offense:
{{conv_date}}
Conviction City:
{{conv_city}}		 Conviction County:
{{conv_county}}		 State of Conviction:
{{conv_state}}
Type of Offense (i.e. robbery):
{{conv_offense}}		 Felony or Misdemeanor?
{{conv_type}}
Result in Incarceration, Probation or Parole?
X Yes X No
Date Incarceration/ Probation/Parole completed:
{{conv_date_incarc_compl}}
Any Facts or Circumstances surrounding the Offense, or other information you wish to share?
{{conv_details}}

 
Were you issued a Certificate of Good Conduct or other evidence of rehabilitation?
X Yes   X No
Can you provide a copy, if requested?
X Yes   X No
Is your name found on the National Sex Offender’s List?*
X Yes   X No

** Do not answer this question if you live/work in Nevada or California.
Have you received a Dishonorable Discharge from the Armed Forces?
X Yes   X No

Note: A Dishonorable Discharge will not necessarily result in disqualification from employment. This information will only be used for job-related purposes consistent with applicable law and is only relevant in determining whether the conviction is related to the job for which you are applying. Failure to honestly answer these questions will result in discontinued consideration of the application or termination of employment.
Was the discharge a result of an offense equivalent to a felony conviction in the criminal courts for violent acts, sexual attacks, or theft?
X Yes   X No
Was the discharge a result of an offense equivalent to a misdemeanor conviction in the criminal courts for violent or sexual acts (reckless endangerment, stalking, kidnapping, terrorist threats, rape, child abuse, etc.), theft or dishonesty (shoplifting, burglary, counterfeiting, etc.)?
X Yes   X No

If you answered “yes” to either of the above, please complete the following:
 
Date of Discharge:
{{discharge_date}}

Any Facts or Circumstances surrounding the Offense, or other information you wish to share?
{{discharge_details}}