For individuals with criminal convictions only.

Submit to the Department

1. Criminal History Supplemental Form (PSS_CHS); you can put up to three (3) criminal convictions on one (1) form.

   For each conviction, you must supply:

   1. A statement containing; offense convicted of, date of conviction, location and circumstances of conviction.
   2. A certified copy of all applicable criminal conviction(s), police and court records.
   3. A statement on the current status of parole or probation.
   4. Supporting documentation - reference letters, pardons, rehabilitation, restitution of rights.

Important Information

1. Misrepresentation, falsification or omission of pertinent information may be cause for denial and may result in criminal charges.

Forms

• PSS_CHS - Criminal History Supplemental Form (.pdf, 1 page)

Return to the Apply & Renew page.