PREVIOUS CRIMINAL RECORD (IF NONE, STATE “NONE” - DO NOT LEAVE BLANK)
Please state ALL offenses for which you have been arrested or charged at any time and in any jurisdiction. You MUST include offenses expunged, juvenile offenses and adjudicated of traffic offenses. This section applies even if the charges were dismissed or someone told you the charges would not be on your record. Please use separate sheet for any additional offenses.

I have read the foregoing application. All of the information is true and correct. I understand that if any of this information is not true and correct, this may be a basis for denial of diversion or revocation of diversion.