Have you been convicted of any criminal offense in any state or in federal court (other than minor traffic violations)? |
Have you been convicted of a felony? If yes, have you been issued a Certificate of Relief from Disabilities by the Prisoner Review Board? |
Have you had or do you now have any disease or condition that interferes with your ability to perform the essential functions of your profession, including any disease or condition generally regarded as chronic by the medical community, i.e., (1) mental or emotional disease or condition; (2) alcohol or other substance abuse; (3) physical disease or condition, that presently interferes with your ability to practice your profession? |
Have you been denied a professional license or permit, or privilege of taking an examination, or had a professional license or permit disciplined in any way by any licensing authority in Illinois or elsewhere? |
Have you ever been discharged other than honorably from the armed service or from a city, county, state or federal position? |
Are you more than 30 days delinquent in complying with a child support order? |
Are you in default on an educational loan or scholarship provided/guaranteed by the Illinois Student Assistance Commission or other governmental agency of this State? |