Security Clearance Form - Casa Of Los Angeles Page 2
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1
2
3Are you currently being charged, or have you ever been charged, for any violation(s) of
2.
law other than minor traffic violations - examples of a minor traffic violation include
driving without a license or with a suspended license, speeding, failing to signal, etc.?
Please note that "driving under the influenc
e" and "reckless driving" are not minor
violations. Please mark the appropriate box below and, if "Yes", please explain in the
chart below.
YES
NO
Have you ever been arrested or detained by any law enforcement agency or military
3.
authority including any arrests while a juvenile? Please mark the appropriate box
explain in the chart below. Note: Exclude any arrests which
below and, if "Yes", please
resulted in the successful completion of a deferred entry of judgment program(s) (pre-
trial diversion) or any arrests where the records have been sealed.
YES
NO
If the response to Question 1,2 and/or 3 is "Yes", provide the information requested below
(attach additional sheets if necessary using the same format).
Date
Offense & Location (City/State)
Disposition
As an adult, has a warrant(s) ever been i
4.
ssued for your arrest? Please mark the
appropriate box below and, if "Yes", please explain in the chart below. Include date(s),
: Exclude warrants which resulted in the
reason(s), and disposition of warrant(s). Note
successful completion of a defe
m(s) (pre-trial diversion).
rred entry of judgment progra
YES
NO
Date
Reason
Disposition
Security Clearance (Revised April 2007)
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