Nintex Live Forms

Settings

Time zone

Felon Information Form
Please complete all the information.
The information will be submitted to the SCSO Felon Registration office.
Felon Registration will review this information and call you back to set up an appointment.
This is NOT a registration

First Name *

Middle Name

Last Name *

Maiden Name

AKA Name (also known as)

Date Of Birth *

Social Security Number *

Drivers License number *

Drivers License State

Drivers License Expiration

FelonAddress *

Apartment number:

FelonCity *

FelonState *

FelonZip *

FelonMobilePhone *

FelonHomePhone *

FelonEmail *

FelonHeight *

FelonWeight *

FelonHairColor *

FelonEyeColor *

FelonRace *

FelonGender *

VisionGlasses *

VisionContacts *

FelonBirthCity *

FelonBirthState *

FelonBirthCountry *

Employer Information

Employer

EmployerAddress

EmployerCity

EmployerState

EmployerZip

EmployerPhone

JobDescription

EmployerSupervisor

EmployerStartDate

Vehicle Information

VehicleMake

VehicleModel

VehicleYear

VehicleColor

VehicleTagNumber

VehicleTagState

Important Contacts

FathersFullName *

FathersRace

FathersDateOfBirth

FathersAddress

FathersHomePhone

FathersCellPhone

MothersFullName *

MothersRace

MothersDateOfBirth

MothersAddress

MothersHomePhone

MothersCellPhone

Emergency Contact FullName *

Emergency Contact Relationship *

Emergency Contact Full Address *

Emergency Contact Phone *

Children

(enter full names of all children)

Siblings

(enter full names of all siblings)

. . .

DOCNumber

PriorFelony *

SexOffender *

SexVictimAge

Career Offender

SexSchool

SexSchoolName

GangAffiliation *

GangName

GangDiscussion

Probation / Community Control

Probation *

Probation / CommunityControl *

Probation / CommunityControl Date

Probation Officer Name
*

Probation / CommunityControl Phone

DNASubmitted *

DNAAgency

DNADate

Current Offense

Current Offense County *

Current Offense Sentence *

Current Offense Charges *

Current Offense Sentence Date *

Prison Release Date

Probation Termination Date

Felon Termination Date

Additional Comments

Identifying marks and tattoos

LeftFingers *

LeftHand *

LeftArm *

RightFingers *

RightHand *

RightArm *

Chest *

Abdomen *

LeftLeg *

LeftFoot *

RightLeg *

RightFoot *

Back *

Neck *

Attachments

Add Attachment