Get Disclosure Statement Regarding Criminal Plea Conviction

The Disclosure Statement Regarding Criminal Plea Conviction is a vital form required for individuals applying for licensure. This guide will walk you through the steps necessary to complete this form online accurately and efficiently.

Follow the steps to complete your Disclosure Statement online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill out the applicant information section. Provide your last name, first name, middle name, telephone number, and optionally your email address. Ensure all fields are completed accurately to prevent delays.
3. Enter your social security number or individual taxpayer identification number and date of birth. Ensure your date of birth indicates that you are at least 17 years old.
4. Complete the conviction information section. This includes details such as the arresting agency, plea/conviction date, court name and location, court case/docket number, and violation code(s).
5. Describe the sentence imposed by the court, including details on incarceration and release dates. Provide the probation/parole dates if applicable.
6. In the details of the crime section, provide a thorough description of the facts and circumstances surrounding your conviction. Include relevant information such as who participated in the crime and the circumstances of the victim.
7. Explain why you committed the crime in the designated space. You may attach additional pages if needed for more comprehensive information.
8. Outline any rehabilitation efforts you have made since your conviction. Attach supporting documentation as necessary and include additional pages if required.
9. Review your completed form carefully for any errors or omissions. Once satisfied, sign and date the form certifying that all information is true to the best of your knowledge.
10. Finally, save your changes, download, print, or share the completed form as needed.

Don't delay—complete your Disclosure Statement online today and ensure your application is processed promptly.