Check YES to all that applyCheck NO to all that do NOT applyCrimeSelfOther household memberDate of conviction, guilty plea, no contest plea or pending chargesSentence
YES☐NO☐18 Pa.C.S. § 6320 (relating to sexual exploitation of children)
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NO
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YES☐NO☐23 Pa.C.S. § 6114 (relating to contempt for violation of protection order or agreement)
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NO
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YES☐NO☐Driving under the influence of drugs or alcohol
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YES☐NO☐Manufacture, sale, delivery, holding, offering for sale or possession of any controlled substance or other drug or device
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NO
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YES☐NO☐18 Pa.C.S. Ch. 30 (relating to human trafficking)
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YES☐NO☐18 Pa.C.S. § 5902(b.1) (relating to prostitution and related offenses)
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NO
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Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 6320 (relating to sexual exploitation of children)
Sentence_18 Pa.C.S. § 6320 (relating to sexual exploitation of children)
Date of conviction, guilty plea, no contest plea or pending charges_23 Pa.C.S. § 6114 (relating to contempt for violation of protection order or agreement)
Sentence_23 Pa.C.S. § 6114 (relating to contempt for violation of protection order or agreement)
Date of conviction, guilty plea, no contest plea or pending charges_Driving under the influence of drugs or alcohol
Sentence_Driving under the influence of drugs or alcohol
Date of conviction, guilty plea, no contest plea or pending charges_Driving under the influence of drugs or alcohol
Sentence_Driving under the influence of drugs or alcohol
Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. Ch. 30 (relating to human trafficking)
Sentence_18 Pa.C.S. Ch. 30 (relating to human trafficking)
Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 5902(b.1) (relating to prostitution and related offenses)
Sentence_18 Pa.C.S. § 5902(b.1) (relating to prostitution and related offenses)