Would a DUI conviction or license suspension affect your job?
Please list the exact time and date of your arrest:
Please list the city, county, and/or police agency associated with your arrest:
What reason did the officer tell you he/she had for stopping you?
Select any of the following Field Sobriety Tests that you were given:
For how many seconds? Both legs?
Results of Alco-Sensor test:
Were any of these tests, or any part of the arrest, recorded on video?
What were your breath test results (not the portable Alco-Sensor)?
And the time of the test?
Where you given a blood test?
Yes
No
Where was the blood test administered?
At any time, did you request a test of your own (Blood, Urine, Breath)?
Have you ever had any prior DUI's?
Yes
No
Do you have any other brief comments about your case we should know about before we speak with you?
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