Printed by DPO_______
Date:________________
Number:_____________
APPLICATION FOR JUVENILE COURT RECORD SEAL
KERN COUNTY PROBATION DEPARTMENT
JUVENILE DIVISION
2005 RIDGE ROAD
BAKERSFIELD, CA 93305
(661) 868-4100
Name:
Maiden Name:
AKA:
Address:
(Include address, city, state and zip code)
Phone #:
Age:__________ Birth Date:_______________ Birth Place:
Social Security Number:_______________ Driver’s License/ID Number:
Height:__________ Weight:___________ Hair Color:___________ Eye Color:
Marital Status:____________________ Children:
Length of Residency in Kern County (dates of residence covering moving back and forth, etc.):
WORK HISTORY:
Employer: _____________________________________________________________________
Address:
(Include address, city, state and zip code)
Phone Number: ___________________________________ Position: _____________________
Dates of Employment:
Previous Employer: _____________________________________________________________
Address:
(Include address, city, state and zip code)
Phone Number:
Dates of Employment:
Position: _____________________
EDUCATION:
High School:______________________________ Year graduated:
College:______________________________________________ Degree:
Vocational/Certified Training:
MILITARY:
Military Service: Yes/No (circle one)
Branch:
Dates of Service:
Type of Discharge: Honorable/General/Dishonorable/Medical (circle one)
CURRENT CRIMINAL INVOLVEMENT:
As an adult, have you been convicted of any crime, misdemeanor or felony?
Felony:
Misdemeanor:
State/County:
Are you currently on probation or parole: Yes/No (circle one)
If yes, explain the charges:
Probation Officer/Parole Agent name/phone #:
Do you have a Court case pending anywhere? Yes/No (circle one)
If yes, provide Court case number:
State/County:
Explain:
Reason for seeking juvenile record seal:
I hereby certify by my signature the above facts are true to the best of my knowledge.
Signed:_______________________________________ Date:___________________________
Revised 10-27-10