Your Name (Last, First, Middle)*
# of DUI(s)
Details for each DUI
Date of Last DUI Conviction (Mo/Day/Yr)
Date of Last DUI Sentence Completed (Mo/Day/Yr)
Acquitted but Fingerprinted
Arrested but Not Charged
Committed Other Acts Preventing Canada DUI Entry
Theft Dangerous Driving Assault Possessing or Trafficking drugs or controlled substances Manslaughter
Were you under the age of 18 at the time?
Convicted and Pardoned
Convicted as an Adult
Refused or Deported
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