Form Cr-688-001 - Application For Certification As A Court Reporter (Page 2 of 2) in pdf

Form Cr-688-001 - Application For Certification As A Court Reporter Page 2

Applicant personal data

1. Have you been convicted of a crime, misdemeanor or felony in this state, any other state, by the federal government,

or any other jurisdiction within the past ten years?

Yes

2. Is there a criminal complaint, accusation, or information presently pending against you or are you currently under

indictment in this state, any other state, by the federal government, or any other jurisdiction?

Yes

3. Has any professional or occupational license, certification, or permit held by you, been fined, suspended, revoked,

refused or denied in this state, any other state, by the federal government or any other jurisdiction?

Yes

4. Have you ever had a civil court order, verdict, or judgment entered against you in any court of competent jurisdiction

in this state, any other state, by the federal government, or any other jurisdiction?

Yes

Please attach a letter of explanation for any affirmative answers to the above questions, including charge(s), date

of conviction, civil judgement or order, county jurisdiction, state, and disposition of charges.

Declaration of applicant

I, __________________________________________________________, of good moral character, have not engaged in

PRINT NAME

unprofessional conduct, and have not been determined to be unable to practice with reason, skill and safety due to physical or

mental impairment, do solemnly swear or affirm under penalty of perjury that the personal information I have provided in this

application is true, complete, and correct; that I have carefully read the materials provided describing the duties of a court reporter

in and for the state of Washington; and, that I will perform to the best of my ability, all court reporting acts in accordance with the

law. I have carefully read the questions in the foregoing application and have answered them completely, and pursuant to RCW

9A.72.085, I declare under penalty of perjury under the law of the state of Washington that my answers and all statements made

by me herein are true and correct. Should I furnish any false information in this application, I hereby agree that such act shall

constitute cause for the denial, suspension or revocation of my certification as a court reporter in the state of Washington.

________________________________________________________

SIGNATURE OF APPLICANT

DATE

________________________________________________________

CITY

STATE

UPON FILING, THIS APPLICATION BECOMES A PUBLIC RECORD AND IS SUBJECT TO PUBLIC

DISCLOSURE PROVISIONS PURSUANT TO RCW 42.17.

CR-688-001 CT. REPT. APP. (R/8/98)M/W Page 2 of 2

Form Cr-688-001 - Application For Certification As A Court Reporter Page 2