Get Community Service Agency Self Declaration Of Criminal History

Filling out the Community Service Agency Self Declaration Of Criminal History form is a crucial step for individuals seeking to provide direct service in behavioral health settings. This guide will walk you through each section of the form, ensuring a smooth completion process.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the direct service person in the designated field. Provide the full name as it appears on official documents.
3. Fill in the title of the position for which you are applying. This should accurately reflect your role within the community service agency.
4. Complete the address section by entering your street address, city, and zip code. Ensure that all details are current and accurate.
5. In the facility name section, provide the name of the establishment where services will be rendered. Fill in the city, street address, and zip code for the facility as well.
6. Indicate the state and county of your residence in the specified fields. This information is necessary for verification purposes.
7. Review the attestation section carefully. You must affirm that you are not subject to registration as a sex offender, have not been convicted of specified offenses, and are not awaiting trial on those offenses.
8. For each listed offense, initial the box next to the corresponding statement to confirm the accuracy of your declarations. Be thorough and considerate in your responses.
9. At the end of the form, you will find a signature line. Sign your name to certify that the answers provided are true and correct to the best of your knowledge.
10. Complete the notarization section by providing the date and seeking a notary public to sign and validate your document before submission.
11. Once the form is fully completed and signed, you can save the changes, download the file, print it for your records, or share it as needed.

Complete your Community Service Agency Self Declaration Of Criminal History online today to expedite your application process.