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Attestation and agreement to notify employer

Attestation and Agreement to Notify Employer 2026

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4.6 out of 5

37 votes

The document is an attestation and agreement form where the applicant confirms they have not been convicted of certain disqualifying offenses and agrees to notify their employer within 14 days if charged or convicted of such offenses. It outlines various tiers of disqualifying offenses, including those that lead to permanent exclusion, ten-year exclusion, seven-year exclusion, and five-year exclusion from employment.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your employer's name in the designated field. This is crucial as it identifies who you will notify regarding any disqualifying offenses.
Review the list of disqualifying offenses carefully. Ensure that you have not been convicted, pleaded guilty, or found eligible for intervention concerning any of these offenses.
Sign the document in the provided signature field. This confirms your attestation and agreement to notify your employer within 14 calendar days if necessary.
Finally, print your name clearly in the designated area and date the form to complete it.

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Versions	Form popularity	Fillable & printable
2019	4.6 Satisfied (37 Votes)
2013	4.9 Satisfied (24 Votes)

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Attestation and Agreement to Notify Employer 2026

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How to use or fill out Attestation and Agreement to Notify Employer

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attestation agreement

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