---
kind: "section"
citation: "28 C.F.R. § 4.3"
title: "28"
number: "4.3"
heading: "Contents of application."
url: "https://uscodex.org/cfr/28/4.3"
---

# §4.3. Contents of application.


A person applying for a Certificate of Exemption shall file with the Office of General Counsel, U.S. Parole Commission, 5550 Friendship Boulevard, Chevy Chase, Maryland 20815-7286, a signed application under oath, in seven copies, which shall set forth clearly and completely the following information:

- (a) **The name and address of the applicant and any other names used by the applicant and dates of such use.**
- (b) A statement of all convictions and imprisonments which prohibit the applicant's service under the provisions of the applicable Act.
- (c) Whether any citizenship rights were revoked as a result of conviction or imprisonment and if so the name of the court and date of judgment thereof and the extent to which such rights have been restored.
- (d) The name and location of the employer and a description of the office or paid position, including the duties thereof, for which a Certificate of Exemption is sought.
- (e) A full explanation of the reasons or grounds relied upon to establish that the applicant's service in the office or employment for which a Certificate of Exemption is sought would not be contrary to the purposes of the applicable Act.
- (f) A statement that the applicant does not, for the purpose of the proceeding, contest the validity of any conviction.

## Notes

### Amendments

[44 FR 6890, Feb. 2, 1979, as amended at 46 FR 52354, Oct. 27, 1981]

### Authority

Authority: Secs. 504, 606, 73 Stat. 536, 540 (29 U.S.C. 504, 526); and secs. 411, 507a, 88 Stat. 887, 894 (29 U.S.C. 1111, 1137).

### Source

Source: 44 FR 6890, Feb. 2, 1979, unless otherwise noted.

### Amendments

[44 FR 6890, Feb. 2, 1979, as amended at 46 FR 52354, Oct. 27, 1981]