Any individual who is required to undergo a criminal background check may be asked to fill out this form.
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 phone number?
What is your email address?
Have you ever been arrested?
Have you ever been convicted of a crime?
Have you ever served time in jail or prison?
Are you currently on probation or parole? If so, please explain the circumstances.
Do you have any outstanding warrants?
Have you ever been denied a gun permit?
Have you ever been involuntarily committed to a mental institution?
Are you currently under the care of a mental health professional?
Do you have any physical or mental health conditions that would prevent you from safely using a firearm?
Do you have any allergies?
Do you have any chronic health conditions?
Do you have any mental health conditions?