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SSN

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DOB*

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Did you graduate High School

If No, did you earn a GED ?

Highest Grade Completed

Year of Graduation / GED*

Name of High School

College/Trade School Attended

Major/Degree

If over 24 years of age, do you still live at home

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is English your first language ?

Household Income

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Have you been convicted of a Felony/Misdemeanor Violation?

if yes, list date(s) and conviction

Have you ever been incarcerated

If yes, how long

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If your license is less than 5 years old, or have lived in Maine less than 5 years please list your previous state license

Employment History

Current OR Most recent employer

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Have you ever been convicted of a DWI/OUI Violation

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If yes, list date(s) and Conviction

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