Davis County Drug/DUI Screening Application

Drug/DUI Screening Application

Full Name *

Email *

Date of Birth *

Phone Number *

Home Address *

Street, City, State, ZIP

Case Number(s) *

Please include all active Davis County case numbers

Defense Attorney Name *

If there is not a defense attorney, please enter NA

Do you live in Davis County? *

If no, what county do you live in?

Are you homeless? *

Have you previously participated in the Drug/DUI Court program in Davis County or in any other County/Jurisdiction within the last 2 years? *

Have you previously participated in the RSAT/CATS program within the last 2 years? *

Are you prescribed and taking any narcotic medication? *

Are you currently serving a commitment on another case? *

Do you have any open/pending cases including pending OTSC in other Jurisdictions? *

If yes, what is/are the case numbers?

Have you ever been convicted of an offense that involved the use of a gun or other dangerous weapon or caused serious bodily injury? *

Do you have any outstanding warrants? *

Have you ever been convicted of a felony sex offense, or a registerable misdemeanor sex offense? *

Are you currently on parole? *