(Note: A guilty plea to or conviction of a felony is not an automatic bar to employment; all circumstances will be considered.)
Have you ever pled guilty to, or been convicted of a felony?*
Have you been convicted of any crime in the past 10 years?*
If so, state the nature of the crime(s):*
Date of plea(s) or conviction(s) named above:*
MM slash DD slash YYYY
Name and location of the court(s):*
