<p> Your Agency Here</p><p>REGISTERED SEX OFFENDER RISK LEVEL LOWERING APPLICATION </p><p>NAME: LAST______FIRST______MIDDLE______DATE OF BIRTH ______SOCIAL SECURITY NUMBER ______PHONE NUMBER ______</p><p>YOUR CURRENT OFFENDER RISK LEVEL: LEVEL II ______LEVEL III ______</p><p>DOC # ______Name of Previous DOC /CCO ______</p><p>CURRENT ADDRESS______CITY______STATE______ZIP______</p><p>HOW LONG AT CURRENT ADDRESS ______</p><p>PREVIOUS ADDRESS______CITY ______STATE______ZIP______</p><p>HOW LONG AT ADDRESS______</p><p>MARITAL STATUS______SPOUSE’S NAME______</p><p>CHILDREN: NAME(S) ______AGE ______</p><p>HAS IT BEEN 5 YEARS SINCE YOU WERE RELEASED FROM CONFINEMENT? YES ______NO ______</p><p>AS PART OF YOUR SENTENCE, WERE YOU REQUIRED TO PARTICIPATE IN A SEX OFFENDER TREATMENT PROGRAM? YES ______NO ______</p><p>HAVE YOU SUCCESSFULLY COMPLETED A SPECIALIZED “SEX OFFENDER SPECIFIC” TREATMENT PROGRAM? YES ______NO ______IF YOU SUCCESSFULLY COMPLETED A PROGRAM, YOU MUST PROVIDE THE TREATMENT PROVIDERS, NAME, ADDRESS & PHONE NUMBER, ALONG WITH A TREATMENT SUMMARY SIGNED BY THE TREATMENT PROVIDER. ______</p><p>HAVE YOU HAD AN EVALUATION WITHIN THE LAST 12 MONTHS WITH A CERTIFIED SEX OFFENDER SPECIFIC TREATMENT PROVIDER, WHICH INCLUDED A POLYGRAPH? YES ______NO ______</p><p>PROVIDE THE DATE OF COMPLETION, THE NAME, ADDRESS & PHONE NUMBER OF TREATMENT PROVIDER AND A COPY OF THE TREATMENT SUMMARY SIGNED BY TREATMENT PROVIDER. ______</p><p>HAVE YOU HAD ANY CRIMINAL ARRESTS OR CONVICTIONS SINCE THE ORIGINAL SEX OFFENSE? YES ______NO ______</p><p>IF YES, PLEASE LIST BELOW - (If necessary, you can include additional information on a separate sheet of paper.) ______</p><p>PRESENT EMPLOYER ______POSITION______ADDRESS______PHONE NO.______START DATE______</p><p>PREVIOUS EMPLOYER______POSITION______ADDRESS______PHONE NO______HOW LONG EMPLOYED BY PREVIOUS EMPLOYER______</p><p>LIST ANY JOB TRAINING AND / OR EDUCATION RECEIVED SINCE CONVICTION: ______</p><p>LIST NAMES AND PHONE NUMBERS OF AT LEAST 3 REFERENCES. ATTACH A COPY OF WRITTEN REFERENCES, INCLUDING REFERENCE FROM DOC/CCO. ______</p><p>PLEASE FILL IN BELOW THE REASON(S) YOU FEEL YOUR RISK LEVEL SHOULD BE LOWERED. ______</p>