Self Reporting Legal History
If you have been convicted of a misdemeanor and/or felony, specific certified/dated copies of court documents (for EACH) conviction are REQUIRED when you submit your application. The certified/dated copies must be current (dated within the past 3 months). Without the REQUIRED documents, the application is considered incomplete and may result in a denial of licensure.
- If this action has been previously submitted to KSBN, just provide the KSBN case number. Do not send a second copy.
- A successfully completed court-ordered Diversion is NOT a conviction, and therefore need not be reported to KSBN.
- To expedite application review, please submit explanatory letter.
Different courts may use different titles for similar court documents.
If you have been disciplined by any other Board (e.g. professional licensure) or governmental agency (e.g. Department of Health and Environment regarding CNA, CMA, or HHA certification, Department of Revenue regarding a driver’s license suspension, cancellation and/or revocation for any reason), you are REQUIRED to provide a certified/dated copy of that Board order or disciplinary/administrative action. You may obtain a copy of your current Driver’s record by going to any driver’s license exam station with a current photo ID and requesting the document. A small fee is usually charged for a copy of your driving record. (Note if this action has been previously submitted to KSBN, just provide the KSBN case number. Do not send a second copy.)
You are REQUIRED to submit an explanatory letter regarding EACH conviction and/or disciplinary/administrative action when it is first reported. The letter should include the following information:
- Date of the criminal offense or disciplinary/administrative action
- Circumstances leading up to the arrest or disciplinary/administrative action
- Actual conviction or disciplinary/administrative action
- Actual sentence or board/regulatory agency order
- Current status of sentence or order
- Rehabilitation (if any)
Subject to Reporting
- All felonies
- And the following categories of misdemeanors:
- Endangerment of a child or vulnerable adult
- Physical, emotional, financial, or sexual exploitation of a child or vulnerable adult
- Physical or verbal abuse
- Violation of a protection from abuse order or protection from stalking order; or any action arising out of a violation of any state or federal regulation.
The following list is not all inclusive but represents the types of court documents that can be obtained from the
office of the Clerk of the Court where the conviction/diversion occurred – City (municipal), County (district/circuit) or Federal Court:
- Uniform Notice to Appear and Complaint (e.g. ticket), Complaint/Petition or Indictment:
- DO NOT submit information regarding speeding or parking tickets
- Amended Complaint/Petition or Indictment
- Indicates charges were increased/decreased from the original charges
- Journal Entry of Judgment (Conviction) and Sentencing
- This may be on the back side of the ticket or a separate piece of paper entitled “Journal Entry”
- Probation Agreement (if any) and current status
- Diversion Agreement (if any) and current status
- Proof that all fines, fees, costs and/or restitution have been paid or record of payment to date