Current Questionnaire Confirmation Personal Information First Name Middle Name Last Name Alias Names? Other Names, AKAs, Also Known As, Maiden Name, All Former Last Names Date Of Birth Social Security Number Gender Male Female Residence History Please list the cities and states where you have resided in the past five years (including current). Criminal History Have you ever been convicted of a traffic or petty offense involving drugs or alcohol, any misdemeanor, or any felony? Yes No More Information "Convicted" is defined as a finding of guilt by a judge or jury; entry of a plea of guilty or no contest (nolo contendre) or entry into a deferred judgment or sentence in which the judgment or sentence is still deferred or the case is still pending. Do you have any criminal charges currently pending, including traffic or petty offenses alleged to involve drugs or alcohol, any misdemeanors, or any felony? Yes No Other History Do you have any criminal charges currently pending, including traffic or petty offenses alleged to involve drugs or alcohol, any misdemeanors, or any felony? Yes No Have you ever been named a Respondent in any dependency, neglect, or child abuse case in any state or country? Yes No Additional Data For any of the previous questions to which you replied "YES", please provide a detailed explanation.
Colorado Judicial Branch