Follow the steps to successfully complete the HI DHS 1200 form.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section I, carefully enter your full name, including last name, first name, and middle initial. After that, provide your signature, Social Security number, birth date, home address, mailing address, home telephone number, and business telephone number.
3. In Section II, start by identifying the agency or client you will serve as a direct service provider or in direct contact with. Be specific and clear in your response.
4. Describe the type of service you will provide for the agency or client. This should detail the nature of your responsibilities and the context of your work.
5. Explain why you believe an exemption should be granted for your criminal conviction or confirmation of abuse. Provide a thorough account of your circumstances and any relevant details.
6. Discuss aspects of your criminal conviction or confirmation of abuse that may indicate that such behavior is unlikely to happen again. Be honest and explanatory.
7. List all significant activities or dates since your criminal conviction or confirmation of abuse, such as employment history, therapy participation, or educational achievements.
8. Provide references by listing their names and telephone numbers. By doing this, you consent to the Department of Human Services contacting these individuals for verification.
9. Lastly, if you have any additional comments regarding your exemption request, include them in the space provided.
10. Once completed, save your changes. You may then download, print, or share the form as necessary. Remember to send the completed HI DHS 1200 form to Fieldprint, Inc. at the address provided.

Complete your request for exemption by filling out the HI DHS 1200 online today!