Statement Regarding Criminal Plea/Conviction

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Statement Regarding Criminal Plea/Conviction

This is an Easy-Fill form that will walk you through the process to fully and accurately complete this form. Upon completion, you will be required to print and submit the document to CSLB.

IMPORTANT NOTES:

Be sure to use the "Back" and "Next" buttons at the bottom of each page - do not use your browser's back arrow because all of your entered information will be erased and you will have to start over.

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To print or order a blank form, please click here to be redirected to CSLB's "Forms and Applications" page.
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APPLICANT AND PLEA/CONVICTION INFORMATION

* Required Entry

*PLEA/CONVICTION LEVEL: *PLEA/CONVICTION LEVEL:
Pane 2

SENTENCE INFORMATION

* Required Entry

Please describe any punishment imposed by the court.
*WERE YOU INCARCERATED?
 








 
Pane 3

PROBATION/PAROLE INFORMATION

* Required Entry

*WERE YOU PUT ON PROBATION OR PAROLE?
 

*HAVE THE FINES BEEN PAID IN FULL?
*HAS THE RESTITUTION BEEN PAID IN FULL?

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CRIME AND REHABILITATION INFORMATION

* Required Entry

Please provide details of this crime, including a complete description of the facts and circumstances that led to your plea/conviction. You should include who participated in the crime; who the victim was; what losses were suffered; and when, where, and how the crime occurred.
What positive changes have you made in your life since this conviction? Please attach documentation to support any rehabilitation efforts.
Pane 5

Review and Edit

Please Review the Following Information

This is a summary of the information that will print on your form. If there are any corrections that need to be made, please choose the Edit button or Back button below to make the change now, as you will not have the opportunity to do so after you submit this page.

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Completion Instructions

NOTICE: This document is not submitted to or saved by CSLB. You must either print it now, save it to your computer, or email it to your email address to print and mail at a later time.

Mail your document(s) along with the application to:


Contractors State License Board
P. O. Box 26000
Sacramento, CA 95826

PDF

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Email the PDF

You can email this document to your email address. This is the same document as in the pdf view and print link above.

This process does not save or submit your document to CSLB. If you email the document to your email address, you will still need to follow the instructions to print and mail it to CSLB.

Finished

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