Criminal History Form
The disclosure of criminal history does not prohibit admission to or participation in theĀ  the internship program.

This form should be completed by each intern.

"Conviction" for this application, means a final judgment or verdict of guilty, a plea of guilty, or a plea of nolo contendere, in any state or federal court, regardless of whether an appeal is pending or could be taken.

"Conviction" does not include a final judgment or verdict that has been expunged by pardon, reversed, set aside or otherwise rendered invalid. Further, you are not required to disclose any arrest(s), criminal charge(s) or conviction(s), the record(s) of which have been erased under law. Such records can include records pertaining to a finding of delinquency or that a child was a member of a family with service needs (Connecticut General Statutes Sec. 46b-146), an adjudication of a youthful offender (Connecticut General Statues Sec. 54-76o) or a criminal charge that has been dismissed or nulled, a criminal charge for which the person has been found not guilty or a conviction for which the person received an absolute pardon (Conn. Gen. Stat. Sec. 54-142a).

Further, any person whose criminal records have been erased is deemed under law never to have been arrested with respect to such erased proceedings and may so swear under oath. Should you have any questions about answering questions on this application, or your rights concerning erased records, please inquire of the Personnel Department in the Office of Legislative Management.
Email *
First Name *
Last Name *
School attending *
Have you ever been convicted of a crime *
If YES, please explain *
Signature: I have answered the above to the best of my ability. I hereby certify that there are no ommisions of any kind, and no misrepresentations or falsifications, and the above answers are true and accurate and are made in good faith. I understand and acknowledge that any omission I have made or misrepresentation or falsification may be grounds to discontinue further consideration of my application, or call for my immediate dismissal from the Legislative Internship Program Note: A typed name will substitute for a handwritten signature *
A copy of your responses will be emailed to the address you provided.
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