The Criminal History Verification Form is available to anyone who needs to verify an individual's criminal background.
What is your full name?
What is your date of birth?
What is your Social Security Number?
What is your current address?
What is your current phone number?
What is your current email address?
What is your current employment status?
Have you ever been convicted of a crime?
If yes, please list the date of conviction, the crime convicted of, and the sentence imposed.
Have you ever been arrested for a crime?
If yes, please list the date of arrest, the crime charged with, and the disposition of the case.
Are you currently on probation or parole?
If yes, please list the terms of probation or parole.
Have you ever been denied a job, housing, or credit because of your criminal history?
Is there anything else you would like to disclose about your criminal history?