Drink / Drug Driving Robot Step 1 of 10 0% Will you be appearing in the Magistrates' Court for drink driving? Please fill in this form if you are going to Court for a drink driving or drug driving charge and want to represent yourself in court on a guilty plea. Be honest and clear with your responses. Please fill in as much information as possible and answer all questions. These are the questions a lawyer would ask when collecting details about your drink driving or drug driving charge and obtaining your instructions for legal representation. This free legal assistance service will ask you for details about your income and personal circumstances. They are required so that your document would show information that is important to the Court. For example, the Court has to know your income if they deem it appropriate to impose a fine. None of the information is stored on the website. My Charge Relates to*Drink DrivingDrug DrivingDrink & Drug DrivingPersonal InformationName* First Last Date of Birth* DD MM YYYY Email* Your email address is only ever used once to forward you the document you create. It is not saved and not used for any other correspondence, nor provided to a third party. Charge InformationThe Drink / Drug Driving Robot service is only to be used if you are pleading guilty to a minor offence which you do not dispute or contest the facts. If you are pleading not guilty (i.e. disputing or contesting the facts in your case), we suggest you engage a lawyer or contact a service that will provide you with legal advice.I am pleading*guiltynot guiltyThe Drink / Drug Driving Robot service is only recommended for those pleading guilty to minor drink or drug driving offences. It is designed to assist those who cannot access nor afford legal representation and ensure they are represented fairly before the Courts. Have you previously been found guilty at Court for a criminal or driving charge?YesNoHave you received an on-the-spot fine or infringement notice (driving ticket)?YesNoIf you have answered yes to either of the questions relating to previous charges or fines, Drink / Drug Driving Robot suggests that you seek legal representation. However, it is recommended that you complete this document in order to assist your lawyer. EmploymentYour work or lack of work is important in deciding a penalty.Current Employment StatusEmployedUnemployedLooking For WorkStudyingWhat are you studying and where?Job TitleWorking HoursFull TimePart TimeHow long have you been looking for work?My weekly income / earnings / government benefits are approximately(Please insert the amount after tax is paid)How much do you have left over after you have paid all your bills?(Bills may include rent, mortgage, transport, phone/internet, gas or power bills, food) RelationshipsYour relationships can be a factor to consider in deciding a penalty.Relationship StatusSingleMarriedDe FactoWidowedSeparatedDivorcedI liveWith ParentsWith HusbandWith WifeWith PartnerWith ChildrenWith FriendsAloneNumber of Children Living With Me Personal CommitmentsPersonal commitments can be important in deciding a penalty.Are you involved in community activities?YesNo(These may include sporting clubs, church, youth groups, charity or other volunteer work)I am involved in the following community activities:Do you know whether you must lose your licence for the charge or offence you are going to Court for?YesNoNot SureI know that I am losing my licence, but I ask it to be kept to the minimum because of:Tick any boxes that are applicable to you. Work Requirements Family Commitments Health Issues Community Involvement Distance from Public Transport Describe the reasons you need your licence loss kept to a minimum:I ask to keep my licence or keep my licence loss at a minimum because ofTick any boxes that are applicable to you. Work Requirements Family Commitments Health Issues Community Involvement Distance from Public Transport Describe the reasons you need your licence loss kept to a minimum:I am unsure whether I have to lose my licence. If it is possible to keep it or keep the loss to a minimum, it is important to me because:Tick any boxes that are applicable to you. Work Requirements Family Commitments Health Issues Community Involvement Distance from Public Transport Describe the reasons you need to keep your licence or loss be kept to a minimum: HealthYour health can be important in deciding a penalty.Do you have any physical health problems the Court should be aware of?YesNoPlease give details of your diagnosis and list any medication you are on:If you have health issues, you should consider getting a letter from your doctor or medical specialist as it may assist the Court in determining your penalty. Are you currently consulting a psychiatrist or psychologist? Have you engaged in any counselling since the offence?YesNoPlease give brief details of your diagnosis:If you are consulting a mental health professional, you should consider getting a letter from the person you have been seeing as it may assist the Court in determining your penalty. Personal GrowthThese personal details can be helpful in deciding an appropriate penalty.Do you want to explain why you committed the offence?YesNoPlease outline the reasons for your offending:Have you learned anything positive from your offending?YesNoWhat lessons have you learned from your offending? Explain below:Do you think that going to Court for this offence has changed your attitude?YesNoExplain how your attitude will be different in the future:Why are you not a risk of committing a similar offence in the future?Please give details below:Do you want to tell the Court why you are not at risk of committing a drink or drug driving offence in the future?YesNoI believe I am not a risk to commit this type of offence in the future because: Terms*I understand that the Drink / Drug Driving Robot is not a real lawyer. The reading or use of information from this website does not create a client-lawyer relationship. I understand that this form is not legal advice.You have now completed all fields, feel free to go back and review your answers. If you are satisfied with the information you have entered, please click submit. Once you have submitted your answers, you cannot review this document again, although you may complete the form again if you wish. You will receive an email with a Personal Instructions document and a Character Reference Guide. Please print 2 copies of the document and take them with you to Court (one for the Court and one for yourself). This iframe contains the logic required to handle Ajax powered Gravity Forms.