Form CT-13 at a glance
What it is: State of Connecticut Addendum to the Application for Examination or Employment (CT-13).
Who signs: Under SECTION 2: APPLICANT CERTIFICATION, sign as Applicant signature and enter the Date (Signature is required). A typed name will substitute for a handwritten signature.
You are required to complete this form if the job/position posting states that you must fill out the CRIMINAL CONVICTIONS form (CT-13) or you are requested to fill out the form by a hiring agency.
A filled-in Form CT-13 example: an applicant answers No to the conviction question
How to fill out Form CT-13, box by box
Applicant information and other names
Under SECTION 1: APPLICANT INFORMATION, enter your LAST NAME, FIRST NAME, MI and SUFFIX (i.e., Jr., MD, Ph.D.).
Enter your MAILING ADDRESS (P.O. Box # or house number and street), APARTMENT # (if any), CITY, STATE and ZIP CODE.
Enter your SOCIAL SECURITY NUMBER.
If name was different, list all name(s) used. Include last name, first name and middle initial for each.
Signature and date
Under SECTION 2: APPLICANT CERTIFICATION, sign as Applicant signature and enter the Date (Signature is required).
A typed name will substitute for a handwritten signature.
I understand that if I knowingly make any misstatement of fact, I am subject to disqualification and dismissal and to such other penalties as may be prescribed by law or personnel regulations.
Convicted or charged
Under SECTION 3: CRIMINAL CONVICTIONS, mark Yes or No: Have you ever been CONVICTED of an offense against criminal or military law, or are there criminal charges currently pending against you? (Exclude minor traffic violations or any offense settled in juvenile court or under a youth offender law.)
If you answered "Yes", please provide a detailed explanation about the nature of the conviction, degree of rehabilitation and time since release. Attach an additional sheet of paper if necessary.
More rules for Form CT-13
You are not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have been erased pursuant to Connecticut General Statutes § 46b-146, 54-76o, or 54-142a.
If your criminal records have been erased pursuant to one of these statutes, you may swear under oath that you have never been arrested.
Sources
[1] Form CT-13 (Rev. 8/7/25), Addendum to the Application for Examination or Employment, State of Connecticut Department of Administrative Services (the Official source link on this page).