Criminal Background Self Declaration Form -mercyhands

Criminal Background Self Declaration Form

Answer the following questions to the best of your knowledge. Any falsified information will result in immediate rejection of application or in immediate dismissal if falsification is discovered after appointment.

First name

Last name

Have you ever been arrested or convicted of a crime?

Yes

Have you ever been accused of any offense related to drug or alcohol abuse?

Yes

Have you ever been involved in any violent behavior or domestic abuse?

Yes

Have you ever been accused of theft or fraud?

Yes

Have you ever been involved in any gang-related activities or organized crime?

Yes

Have you ever been involved in any activities related to terrorism or extremist ideologies?

Yes

Have you ever been accused or been involved in any sexual exploitation, abuse, or harassment?

Yes

Have you ever been accused or been involved in any child or elderly exploitation, abuse, or harassment?

Yes

Have you ever been involved in any activity that could bring disrepute to yourself or your employer?

Yes

Are you currently under investigation for any criminal offense?

Yes

If you answer Yes to any of the above question then please describe here

Comments

I hereby certify that, to the best of my knowledge and belief, all of the information I provide in this form is true, complete and made in good faith. I understand that false and fraudulent information provided herein may disqualify me from further consideration for employment and, if employed, may result in termination of employment if discovered at a late date.

Your Signature

Date