A digital services project by FlexionApplication for Pardon After Completion of Sentence
13 groups130 fields8 pages1 low confidence
Pages
1.Personal Information
Basic personal identification and contact information
- Background Information
- First nametext
- Middle name (if you have one)text
- Last nametext
- First name at time of convictiontext
- Middle name at time of convictiontext
- Last name at time of convictiontext
- Other names (married, maiden, aliases, etc.)text
- Social security numbertext
- Date of birth (Month, Day, Year)date
- Country where you were borntext
- City and state where you were borntext
- Citizenshipchoice
- Parent #1's full name (maiden name in parentheses)text
- Parents #2's full name (maiden name in parentheses)text
- Street addresstext
- Apartment/Unittext
- City, Statetext
- Zip codetext
- Your email address or email of a trusted personemail
- Phone numberphone
- Name of attorney helping with this applicationtext
- Attorney's email address and phone numbertext
- Have you applied for federal commutation or pardon before?choice
- Date applied (month/year)text
- Date of decision (month/year)text
- Are you Hispanic or Latino?choice
- Race (select all that apply)choice
- Sexchoice
- Current marital statuschoice
- Spouse / partner nametext
- Date of marriage or civil union/domestic partnershipdate
- Place of marriage or civil union/domestic partnershiptext
2.Reasons and Community Involvement
Why you are seeking a pardon and your community activities
- Reasons for Seeking Pardon
- What are your reasons for seeking pardon?longText
- Community Activities
- How have you been involved in your community since your conviction?longText
- Description of activitytext
- Approximate start and end dates (year to year)text
- Who can tell us about your participation in the above activities? Name(s)text
- Contact informationtext
3.Education and Housing
Educational achievements and places you have lived
- Educational and Licensing Opportunities
- School or program nametext
- Subject studied and degree or certification receivedtext
- Approximate dates attended (month/year to month/year)text
- License Typetext
- Approximate date issued (year)text
- Places Lived
- Street addresstext
- Apartment/Unittext
- City, statetext
- Zip codetext
- Approximate dates living there (month/year to month/year)text
- If you are experiencing homelessness or have in the past, note the dates. (month/year to month/year)text
4.Military and Employment History
Military service and employment information for the last seven years
- Military Service
- Have you served in the military?choice
- Dates of servicetext
- Branch(es)text
- Serial numbertext
- Type of dischargetext
- Tell us briefly about your military servicelongText
- Job History
- Current employertext
- Type of businesstext
- Positiontext
- Month/year startedtext
- Employer street addresstext
- City, statetext
- Zip codetext
- Supervisor name and phone numbertext
- If you are currently unemployed or have been in the past, give the dates and share how you supported yourself during that timelongText
- If your criminal record has affected your ability to find work, give details herelongText
- If you have been fired, accused of misconduct at a job, or given an unsatisfactory job performance rating, give details herelongText
5.Substance Use and Financial Information
History with substance use and current financial situation
- Sobriety and Substance Use
- Have you struggled with substance use?choice
- Type of drug or alcoholtext
- How often were you using?text
- Approximate dates used (month/year to month/year)text
- Diagnosistext
- Date of diagnosis (month/year)text
- Facility/counselor/doctor nametext
- When did you attend? (month/year to month/year)text
- Street addresstext
- Suite no.text
- City, statetext
- Zip codetext
- Phone numberphone
- Email addressemail
- How long have you been sober? Days, months, or yearstext
- Is there anything else you would like to share about your history with sobriety and substance use?longText
- Financial Information
- Description of debt that is late or in defaulttext
- Approximately how much is the debt?currency
- Court where bankruptcy filedtext
- Approximate year bankruptcy filed and outcometext
- Approximately how much debt did you want to discharge?currency
- Is there anything else you would like to share about your experience with finances since your conviction?longText
6.Criminal History
Details about the conviction for which you seek pardon and other criminal history
- Case Background and Other Criminal History
- Did you plead guilty?choice
- Approximate date(s) of offense (month/year to month/year)text
- Approximate date you were sentenced (month/year)text
- Court where you were prosecuted (D.C. Superior Court, military court, or name of U.S. District Court)text
- Case numbertext
- Of what were you convicted?longText
- Prison sentence (months or years)text
- Approximate date you were released from prison, community confinement, or home detention (month/year)text
- Sentence for probation or supervised release (months or years)text
- Approximate date you completed your term of probation or supervised release (month/year)text
- Assessment amountcurrency
- Fine amountcurrency
- Restitution amountcurrency
- Tell us about your conduct for which you were convictedlongText
- Do you accept responsibility for your conduct? Explain why or why not.longText
- Tell us about any other criminal historylongText
7.Certification and Authorization
Legal certification, oath, and authorization for background investigation
- Certification and Personal Oath
- I certify, under penalty of perjury, that all information in my petition and any document submitted with it were given or authorized by me and that I reviewed and understand the information contained in, and submitted with, my petition.boolean
- In petitioning the President of the United States for pardon, I do solemnly swear that I will be law-abiding and will support and defend the Constitution of the United States against all enemies, foreign and domestic, and that I take this obligation freely and without any mental reservation whatsoever.boolean
- Daynumber
- Monthtext
- Yearnumber
- Authorization for Release of Information
- Signature (sign in ink)text
- Full Name (type or print legibly)text
- Date Signeddate
- Other Names Usedtext
- Street Addresstext
- Citytext
- Statetext
- ZIP Codetext
- Home Telephone Number (include area code)phone
- Social Security Numbertext
8.Letters of Support
Three required letters of support from non-relatives
- Letters of Support
- Primary reference (select exactly 3)boolean
- Name of petitionertext
- I certify that I have personally known the petitioner for ___ yearsnumber
- I am not related to petitioner by blood or marriageboolean
- In support of this pardon petition, I state the below:longText
- Signaturetext
- Print Nametext
- Datedate
- Addresstext
- Phone numberphone
- Email addressemail
Groups
Federal pardon application for individuals who have completed their sentence and seek presidential pardon.
Background Information
Personal identification and contact information
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| First name | Text | Yes | — | |
| Middle name (if you have one) | Text | No | — | |
| Last name | Text | Yes | — | |
| First name at time of conviction | Text | No | — | |
| Middle name at time of conviction | Text | No | — | |
| Last name at time of conviction | Text | No | — | |
| Other names (married, maiden, aliases, etc.) | Text | No | — | |
| Social security number | Text | Yes | — | |
| Date of birth (Month, Day, Year) | Date | Yes | — | |
| Country where you were born | Text | Yes | — | |
| City and state where you were born | Text | Yes | — | |
| Citizenship | Choice | Yes | — | |
| Parent #1's full name (maiden name in parentheses) | Text | No | — | |
| Parents #2's full name (maiden name in parentheses) | Text | No | — | |
| Street address | Text | Yes | — | |
| Apartment/Unit | Text | No | — | |
| City, State | Text | Yes | — | |
| Zip code | Text | Yes | — | |
| Your email address or email of a trusted person | No | — | ||
| Phone number | Phone | No | — | |
| Name of attorney helping with this application | Text | No | — | |
| Attorney's email address and phone number | Text | No | — | |
| Have you applied for federal commutation or pardon before? | Choice | Yes | — | |
| Date applied (month/year) | Text | No | — | |
| Date of decision (month/year) | Text | No | — | |
| Are you Hispanic or Latino? | Choice | No | — | |
| Race (select all that apply) | Choice | No | — | Review |
| Sex | Choice | No | — | |
| Current marital status | Choice | No | — | |
| Spouse / partner name | Text | No | — | |
| Date of marriage or civil union/domestic partnership | Date | No | — | |
| Place of marriage or civil union/domestic partnership | Text | No | — |
Reasons for Seeking Pardon
Explanation of why you are seeking a pardon and how it would help you
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| What are your reasons for seeking pardon? Include how your life would change if granted pardon and challenges you have faced because of your conviction | LongText | Yes | — |
Community Activities
Your involvement in community activities since conviction
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| How have you been involved in your community since your conviction? Community can include family, neighborhood, city, prison community, or organizations and associations | LongText | No | — | |
| Description of activity | Text | No | — | |
| Approximate start and end dates (year to year) | Text | No | — | |
| Who can tell us about your participation in the above activities? Name(s) | Text | No | — | |
| Contact information | Text | No | — |
Educational and Licensing Opportunities
Educational programs and licenses obtained or denied
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| School or program name | Text | No | — | |
| Subject studied and degree or certification received | Text | No | — | |
| Approximate dates attended (month/year to month/year) | Text | No | — | |
| License Type | Text | No | — | |
| Approximate date issued (year) | Text | No | — |
Places Lived
Addresses where you have lived in the last three years
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| Street address | Text | No | — | |
| Apartment/Unit | Text | No | — | |
| City, state | Text | No | — | |
| Zip code | Text | No | — | |
| Approximate dates living there (month/year to month/year) | Text | No | — | |
| If you are experiencing homelessness or have in the past, note the dates. (month/year to month/year) | Text | No | — |
Military Service
Military service history if applicable
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| Have you served in the military? | Choice | No | — | |
| Dates of service | Text | No | — | |
| Branch(es) | Text | No | — | |
| Serial number | Text | No | — | |
| Type of discharge | Text | No | — | |
| Tell us briefly about your military service Include tours of duty, time overseas or in active combat, disciplinary sanctions, commendations or medals, or other notable achievements | LongText | No | — |
Job History
Employment history for the last seven years
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| Current employer | Text | No | — | |
| Type of business | Text | No | — | |
| Position | Text | No | — | |
| Month/year started | Text | No | — | |
| Employer street address | Text | No | — | |
| City, state | Text | No | — | |
| Zip code | Text | No | — | |
| Supervisor name and phone number | Text | No | — | |
| If you are currently unemployed or have been in the past, give the dates and share how you supported yourself during that time | LongText | No | — | |
| If your criminal record has affected your ability to find work, give details here | LongText | No | — | |
| If you have been fired, accused of misconduct at a job, or given an unsatisfactory job performance rating, give details here | LongText | No | — |
Sobriety and Substance Use
History with substance use and treatment
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| Have you struggled with substance use? | Choice | No | — | |
| Type of drug or alcohol | Text | No | — | |
| How often were you using? | Text | No | — | |
| Approximate dates used (month/year to month/year) | Text | No | — | |
| Diagnosis | Text | No | — | |
| Date of diagnosis (month/year) | Text | No | — | |
| Facility/counselor/doctor name | Text | No | — | |
| When did you attend? (month/year to month/year) | Text | No | — | |
| Street address | Text | No | — | |
| Suite no. | Text | No | — | |
| City, state | Text | No | — | |
| Zip code | Text | No | — | |
| Phone number | Phone | No | — | |
| Email address | No | — | ||
| How long have you been sober? Days, months, or years | Text | No | — | |
| Is there anything else you would like to share about your history with sobriety and substance use? | LongText | No | — |
Financial Information
Information about debts, defaults, and bankruptcy filings
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| Description of debt that is late or in default | Text | No | — | |
| Approximately how much is the debt? | Currency | No | — | |
| Court where bankruptcy filed | Text | No | — | |
| Approximate year bankruptcy filed and outcome | Text | No | — | |
| Approximately how much debt did you want to discharge? | Currency | No | — | |
| Is there anything else you would like to share about your experience with finances since your conviction? | LongText | No | — |
Case Background and Other Criminal History
Details about the conviction for which you seek pardon and any other criminal history
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| Did you plead guilty? | Choice | Yes | — | |
| Approximate date(s) of offense (month/year to month/year) | Text | Yes | — | |
| Approximate date you were sentenced (month/year) | Text | Yes | — | |
| Court where you were prosecuted (D.C. Superior Court, military court, or name of U.S. District Court) | Text | Yes | — | |
| Case number | Text | Yes | — | |
| Of what were you convicted? | LongText | Yes | — | |
| Prison sentence (months or years) | Text | No | — | |
| Approximate date you were released from prison, community confinement, or home detention (month/year) | Text | No | — | |
| Sentence for probation or supervised release (months or years) | Text | No | — | |
| Approximate date you completed your term of probation or supervised release (month/year) | Text | No | — | |
| Assessment amount | Currency | No | — | |
| Fine amount | Currency | No | — | |
| Restitution amount | Currency | No | — | |
| Tell us about your conduct for which you were convicted Include your role in the offense, how/when/why you got involved, and what actions you took | LongText | Yes | — | |
| Do you accept responsibility for your conduct? Explain why or why not. | LongText | Yes | — | |
| Tell us about any other criminal history List any other arrests or convictions that may appear on your criminal history record, including juvenile and expunged records | LongText | No | — |
Certification and Personal Oath
Legal certification and oath required for submission
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| I certify, under penalty of perjury, that all information in my petition and any document submitted with it were given or authorized by me and that I reviewed and understand the information contained in, and submitted with, my petition. | Boolean | Yes | — | |
| In petitioning the President of the United States for pardon, I do solemnly swear that I will be law-abiding and will support and defend the Constitution of the United States against all enemies, foreign and domestic, and that I take this obligation freely and without any mental reservation whatsoever. | Boolean | Yes | — | |
| Day | Number | Yes | — | |
| Month | Text | Yes | — | |
| Year | Number | Yes | — |
Letters of Support
Three required letters of support from non-relatives
| Field | Type | Required | Conditions | Status |
|---|---|---|---|---|
| Primary reference (select exactly 3) | Boolean | No | — | |
| Name of petitioner | Text | Yes | — | |
| I certify that I have personally known the petitioner for ___ years | Number | Yes | — | |
| I am not related to petitioner by blood or marriage | Boolean | Yes | — | |
| In support of this pardon petition, I state the below: Include how you know the individual, what you know of their reputation and conduct since their conviction, and their personal and professional activities | LongText | Yes | — | |
| Signature | Text | Yes | — | |
| Print Name | Text | Yes | — | |
| Date | Date | Yes | — | |
| Address | Text | Yes | — | |
| Phone number | Phone | Yes | — | |
| Email address | Yes | — |