Loading
Form preview picture

Get OH Attestation And Agreement To Notify Employer 2019-2024

Attestation and Agreement to Notify Employer I hereby attest that I have not been convicted of or pleaded guilty to any of the disqualifying offenses listed below and agree that I will notify Employer s Name within 14 calendar days if while employed I am formally charged with am convicted of or plead guilty to one of the disqualifying offenses. I understand that failure to make this notification may result in termination of employment. Applicant s Signature Date Signed Applicant s Name Printed Tier 1 Disqualifying Offenses Permanent Exclusion 2903. 01 aggravated murder 2903. 02 murder 2903. 03 voluntary manslaughter 2903. 11 felonious assault 2903. 15 permitting child abuse 2903. 16 failing to provide for a functionally impaired person 2903. 34 patient abuse and neglect 2905. 01 kidnapping 2905. 02 abduction 2905. 32 human trafficking 2905. 33 unlawful conduct with respect to documents 2907. 02 rape 2907. 03 sexual battery 2907. 04 unlawful sexual conduct with a minor formerly corruption of a minor 2907. 05 gross sexual imposition 2907. 06 sexual imposition 2907. 07 importuning 2907. 08 voyeurism 2907. 31 disseminating matter harmful to juveniles 2907. 32 pandering obscenity 2907. 323 illegal use of minor in nudity-oriented material or performance Rule 5123 2-2-02 effective January 1 2013 Page 1 of 4 2909. 22 soliciting/providing support for act of terrorism 2909. 23 making terrorist threat 2909. 24 terrorism 2913. 40 Medicaid fraud 2923. 01 conspiracy when the underlying offense is any of the offenses or violations on this list 2923. 02 attempt when the underlying offense is any of the offenses or violations on this list 2923. 03 complicity when the underlying offense is any of the offenses or violations on this list A conviction related to fraud theft embezzlement breach of fiduciary responsibility or other financial misconduct involving a federal or state-funded program excluding the disqualifying offenses set forth in section 2913. 46 of the Revised Code illegal use of supplemental nutrition assistance program SNAP or women infants and children WIC program benefits. A violation of an existing or former municipal ordinance or law of this state any other state or the United States that is substantially equivalent to any of the offenses or violations on this list. 2903. 04 involuntary manslaughter 2903. 041 reckless homicide 2905. 04 child stealing as it existed prior to July 1 1996 2905. 05 criminal child enticement 2905. 11 extortion 2907. 21 compelling prostitution 2907. 22 promoting prostitution 2907. 23 enticement or solicitation to patronize a prostitute procurement of a prostitute for another 2909. 03 arson 2911. 11 aggravated burglary 2913. 46 illegal use of supplemental nutrition assistance program SNAP or women infants and children WIC program benefits 2913. 48 workers compensation fraud 2913. 49 identity fraud 2917. 02 aggravated riot 2923. 12 carrying concealed weapon 2923. 122 illegal conveyance or possession of deadly weapon or dangerous ordnance in a school safety zone illegal possession of an object indistinguishable from a firearm in a school safety zone 2923.

How It Works

immunodeficiency rating
4.8Satisfied
72 votes

Tips on how to fill out, edit and sign Disseminating online

How to fill out and sign Functionally online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Business, legal, tax along with other documents need a high level of protection and compliance with the law. Our forms are regularly updated in accordance with the latest legislative changes. In addition, with our service, all of the data you include in your Attestation And Agreement To Notify Employer is well-protected against loss or damage by means of top-notch file encryption.

The tips below can help you complete Attestation And Agreement To Notify Employer quickly and easily:

  1. Open the form in the feature-rich online editor by hitting Get form.
  2. Complete the required fields that are marked in yellow.
  3. Press the green arrow with the inscription Next to move on from box to box.
  4. Go to the e-signature solution to e-sign the template.
  5. Insert the date.
  6. Look through the entire e-document to be sure that you haven?t skipped anything.
  7. Hit Done and save the resulting document.

Our platform enables you to take the entire procedure of submitting legal documents online. As a result, you save hours (if not days or weeks) and get rid of additional costs. From now on, fill out Attestation And Agreement To Notify Employer from your home, business office, and even while on the go.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to OH Attestation And Agreement To Notify Employer

  • unruliness
  • personating
  • immunodeficiency
  • Prohibitions
  • attestation
  • Hostelry
  • falsification
  • telecommunication
  • disseminating
  • enticement
  • compounding
  • functionally
  • disqualifying
  • cultivation
  • anabolic
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.