Licensure - Criminal Conviction Eligibility Petition

An individual who is concerned past criminal convictions may affect his or her ability to become licensed may complete this form prior to applying for a license or taking other steps to obtain a license. The Board will review the petition and make a determination as to whether or not the criminal history would make a person ineligible for a license.This pre-determination process is optional and not mandatory.An individual with criminal convictions may apply for a license without filing this petition. In that case, the criminal history will be reviewed as part of the overall application.

Click here to download the petition form PDF

Click here to download a list of potentially disqualifying criminal convictionsPDF