What is your full name?
What is your address?
How long have you been at that address?
What is your date of birth?
What is your race or nationality?
Are you a citizen of the United States of America?
If so, what is your social security number?
What is your home telephone number?
Who is your employer?
What is your work telephone number?
What is your email address?
Do you have a drivers’ license?
If yes, from what state is your drivers' license issued?
If no, have you ever had a drivers’ license?
Do you own any automobiles or any other motor-vehicles?
If yes, please list them:
Do you own a gun?
What is your marital status?
Do you have any young children?
If so, how many and what are their ages?
What is your highest level of education?
If you went to college, what was your major and your year of graduation?
Is there any additional education history?
Do you own a home?
Do you suffer from any chronic illness?
If yes, please explain:
Have you ever been hospitalized for a mental illness?
Are you on any medications?
If yes, please list:
Have you had any problems with substance abuse or have you ever stayed at a rehab or detox center?
Have you ever been treated by a behavioral therapist or a psychiatrist?
If yes, please explain.
Do you consider yourself to be in good health?
If no, explain:
What was the date and time of your arrest?
Where was the location of arrest?
Was there a reason or explanation given for your arrest?
Did the police have a warrant?
What crime were you charged with?
Was anyone else involved at the time?
Was your property searched?
If Yes, explain:
Did the police find anything that they kept?
Were you read your rights?
Did you give any statements or sign anything since the incident?
If yes, what?
If yes, explain:
Do you have a criminal record prior to this episode?
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