COTO Pre-Screening FormDate(Required)Applicant Name(Required)Applicant Email(Required)Applicant Phone Number(Required)Criminal HistoryConviction(Required)Do you have a criminal history (misdemeanor or felony, not including traffic charges)? Yes No Probation Status(Required)Are you currently on state or federal probation or post-release? Yes No Employment Status and Criminal History(Required)Are you currently employed? Yes No Employment Status and Criminal History(Required)Have you experienced barriers to employment? Yes No Employment Status and Criminal History(Required)Does your criminal history keep you from obtaining employment? Yes No Pending Charges(Required)Do you currently have any Pending charges? Yes No County(Required) Alamance Caswell Guilford Randolph Rockingham Other What county(s) is your court date in? Δ
