Have you been convicted of any crime of the first, second, third or fourth degree within the most recent 10 years?
For purposes of this question, you must report any crime to which you pled guilty or were found guilty by a court of competent Jurisdiction.
You need not report any conviction that has been expunged. _ Yes _ No
Read the question referring to being convicted of any crime of the first, second, third or fourth degree within the past 10 years.
Respond to question by clicking in the 'Yes' or 'No' button. (Click again to de-select).
If your response is 'Yes', enter the following data.
State: Select from the drop down list
Conviction Date: Enter date.
Reporting Entity: Enter entity name.
Description of Crime: Enter text
You can add an additional conviction by clicking on the 'Click here to add additional convictions' button, and proceed as above. (You may add multiple convictions.)
If you disagree with the information or the information is incorrect, you can dispute the action by following the disputed steps.
Disputed The default is NO. If you want to dispute this event, please choose YES.
Dispute Reason Required when choosing YES to an action
Your dispute will be directed to the New Jersey Board of Medical Examiners for review.
When finished, click one of the buttons at the bottom of the screen:
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