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Psychological History Report
<br /> Anger,Problems (555-66-7779) 29-Nov-01
<br /> Has never been the driver in a traffic accident in which there was serious injury or death.
<br /> (El 0,a,96%,100%)(0)
<br /> Has never left the scene of an accident in which he was involved. (E11,a,98%,100%)(0)
<br /> Has no current outstanding traffic warrants. (E12,a,99%,100%)(0)
<br /> Has auto insurance or a deposit on file for all vehicles that he owns and operates. (E13,b,92%,100%)(0)
<br /> Financial History
<br /> • Is able to pay monthly bills on time only some of the time. (F1,c,4%,4%)(2)
<br /> Has never had any of the following financial problems
<br /> chapter 7 bankruptcy (F2,a,93%,100%)(0)
<br /> chapter 13 bill consolidation (F3,a,95%,100%)(0)
<br /> repossession of property (F5,a,93%,100%)(0)
<br /> wages garnished (F6,a,93%,100%)(0)
<br /> Has had the following financial problems
<br /> • being referred to a collection agency (F4,b,46%,46%)(1)
<br /> Does not have an educational loan that is delinquent. (F7,a,97%,100%)(0)
<br /> Has never failed to file an income tax return. (F8,a,95%,100%)(0)
<br /> Has gambled$50 or less on a single day. (F9,b,49%,81%)(0)
<br /> Has never owed money on a gambling debt. (F10,a,99%,100%)(0)
<br /> Has never had a problem with betting money or gambling. (F11,a,100%,100%)(0)
<br /> No one has ever criticized his gambling. (F12,a,100%,100%)(0)
<br /> Gambling has never caused problems in his work or personal life. (F13,a,100%,100%)(0)
<br /> Legal History
<br /> • Has been questioned as a suspect in a crime. (G1,b,12%,12%)(1)
<br /> Has been questioned as a witness in a crime. (G2,b,24%,24%)(0)
<br /> => Has never been arrested. (G3,a,77%,100%)(0)
<br /> Has never been convicted, pleaded guilty, or pleaded no contest to a misdemeanor. (G4,a,85%,100%)(0)
<br /> Has never been convicted, pleaded guilty, or pleaded no contest to a felony. (G5,a,99%,100%)(0)
<br /> Has never been on court probation as an adult. (G6,a,94%,100%)(0)
<br /> Has never appeared before a juvenile court for an act which would have been a crime if it had been
<br /> committed by an adult. (G7,a,97%,100%)(0)
<br /> Has never been involved as a plaintiff, defendant, petitioner, or respondent in a civil court action.
<br /> (G8,a,80%,100%)(0)
<br /> Has never applied for a permit to carry a concealed weapon. (G9,a,88%,100%)(0)
<br /> • Has carried, on person or in vehicle,a weapon for protection. (G10,b,13%,13%)(1)
<br /> Since age 18, has never stolen from anyone. (G11,a,92%,100%)(0)
<br /> => Has not stolen from anyone in the last 3 years. (G12,a,97%,100%)(0)
<br /> Has never bought property he suspected was stolen. (G13,a,95%,100%)(0)
<br /> Has never sold property he suspected was stolen. (G14,a,99%,100%)(0)
<br /> Arson (intentionally setting a fire):
<br /> Has never committed or been arrested for it. (G15,e,99%,100%)(0)
<br /> Forgery(signing another person's name to a document,without permission or authorization):
<br /> Has never committed or been arrested for it. (G16,e,100%,100%)(0)
<br /> Embezzlement(theft of money or other valuables entrusted to you):
<br /> Has never committed or been arrested for it. (G17,e,97%,100%)(0)
<br /> _>Verify with applicant . Serious admission ..Conditional DQ admission ,, Unconditional DQ admission ??Unanswered
<br /> 7/31/ffi-SYLEPS PLLC PsyQ_190520 40
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