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Criminal history affidavit 2026
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- Click ‘Get Form’ to open the criminal history affidavit in the editor.
- Begin by entering your full name (First, Middle, Last) in the designated field.
- Provide your date of birth in the format MM/DD/YY to ensure accurate identification.
- Fill in your complete address, including street number, city, state, and ZIP code.
- Indicate whether you have been convicted of any crimes by checking the appropriate box and providing details if applicable.
- Complete the section regarding sex offender registration status by selecting the relevant option.
- Certify that your self-disclosure is true and accurate by signing and dating the affidavit at the bottom.
- If required, have a notary public witness your signature and complete their section for validation.
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lcr 1034a
a. Affidavit. For the purpose of fingerprinting and criminal background history checks, the term affidavit means the use of Mississippi State Department
Complete this form immediately upon beginning employment, and at the time of reapplication for a Fingerprint Clearance Card.