Criminal Convictions

  • Written Statement

    A detailed written statement using the Background Statement Form, to describe the actions which led to the arrest and/or conviction. The form must be completed for each conviction. Each of form must have an original signature and be dated. The written statement should include the following information:

    • Circumstances detailing the actions which led to the arrest and conviction
    • Name of arresting agency and dates of the arrest and conviction
    • Specific arrest and conviction charges
    • When applicable, explanations regarding any failure to appear in court, violations of probation, and/or commitment to state or federal prison
    • A summary of the court sentence
  • Certified Reports and Documents
  • Evidence of Rehabilitation
    • A detailed explanation of efforts at rehabilitation or changes made to prevent future occurrences
    • Individuals are responsible to present sufficient evidence of rehabilitation to demonstrate fitness for licensure
    • See Background Statement Form for additional information