NAU Park Ranger Training Program

Criminal Offense Checklist

Full Name (Print): ________________________________________________

Have you ever been:  

1. Arrested? 

 ___Yes  ___  No
2. Charged by any law enforcement authority? ___Yes  ___  No
3. Convicted of any offense against the law (including "nolo contendere" or "no contest" pleas)? ___Yes  ___  No
4. Charged with any motor vehicle moving violation (e.g. DUI, reckless driving, speeding)? ___Yes  ___  No
5. Involved in a motor vehicle accident? ___Yes  ___  No
6. Subjected to forfeiture of collateral in connection with an arrest? ___Yes  ___  No
7. Imprisoned? ___Yes  ___  No
8. Placed on probation? ___Yes  ___  No
9. Required to appear before a juvenile court for an act that would have been a crime if committed by an adult? ___Yes  ___  No
10. Diagnosed as having mental or emotional problems? ___Yes  ___  No
11. Been treated for drug or alcohol dependency? ___Yes  ___  No
12. Associated in any manner with any group that advocates resistance and/or violence against the Federal Government? ___Yes  ___  No
13. Been fired from any job for any reason? ___Yes  ___  No

Are you now:

  
14. Charged with an offense by any law enforcement authority? ___Yes  ___  No
15. Presently on bail or out on personal recognizance or other conditional release? ___Yes  ___  No
16. On probation of any type? ___Yes  ___  No

If you answered "Yes" to any part of the above questions, give complete details on separate sheet. Include , as a minimum, the date of the offense charge(s), city and state, name of Law Enforcement Agency involved, and final disposition.

The information that I have provided is true and correct. I understand that any misleading or false information is just cause for refusal of this application. I also understand that false information will result in my dismissal from the Park Ranger Training Program.

Applicant's Signature: __________________________________________  Date: __________

THIS FORM MUST BE NOTARIZED. NOTARY INFORMATION BELOW
   State: _________
   County: _________
   Date: __________
   Notary Public: _____________________
   My commission expires: ______________
   Notary Signature: _____________________________________

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