SLEO 1 Application - Page 2

2. First Name
3. Last Name
5. Social Security Number
7. Phone Number
9. Have you ever been convicted of a 1st, 2nd, 3rd or 4th degree crime, or are you presently under indictment for same? (this applies to expunged convictions)

   1. Yes
   2. No
10. Have you been convicted of a disorderly persons or petty disorderly persons offense in the last 36 months?

    1. Yes
    2. No
12. Have you ever been convicted of any Domestic Violence offense?

    1. Yes
    2. No
13. Have you been convicted of two or more offenses of Driving While Intoxicated (DWI), or Refusal to Take a Breathalyzer Test?

    1. Yes
    2. No
15. Have you been convicted of DWI or Refusal Offense within the last 5 years?

    1. Yes
    2. No
16. Are you currently on probation or have you been on probation within the last 3 years?

    1. Yes
    2. No
18. Are you currently in default of any payments for alimony or child support?

    1. Yes
    2. No
19. Is your driving privilege revoked in New Jersey or in any other state?

    1. Yes
    2. No
21. Have you ever been dishonorably discharged from any branch of the military or any law enforcement agency?

    1. Yes
    2. No
22. Have you been adjudicated delinquent in the last 5 years? (“Adjudicated delinquent” means being found guilty of an indictable offense while you were a juvenile).

    1. Yes
    2. No
24. Are you currently a fugitive from justice?

    1. Yes
    2. No
25. Have you ever renounced your citizenship of the United States?

    1. Yes
    2. No
27. Do you have a high school diploma or GED?

    1. Yes
    2. No
29. SLEO Application Part 3 - Download, sign and notorize
    Application Part 3 for download and signature
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field