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Click ‘Get Form’ to open the DHS 1200 in the editor.
Begin with Section I by entering your full name, including last name, first name, and middle initial. Ensure accuracy as this information is crucial for identification.
Fill in your signature, social security number, birth date, home address, and both home and business telephone numbers. Double-check these details for correctness.
Move to Section II and complete all items regarding your reasons for exemption. Clearly identify the agency or client you will serve and describe the type of service you will provide.
Provide a detailed explanation of why you believe an exemption should be granted based on your criminal history. Include any mitigating factors that demonstrate a low likelihood of reoffending.
List significant activities since your conviction, such as employment or therapy participation. This helps establish your commitment to rehabilitation.
Include references with their contact numbers for verification purposes. You may also attach written statements of support if available.
Finally, add any additional comments regarding your exemption request before submitting the form to Fieldprint, Inc. at the provided address.
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DHS 1200 (Rev. 06/16) Page 1 of 2 State of Hawaii Med-
DHS 1200 (Rev. 06/16). Page 1 of 2. State of Hawaii. Med-QUEST Division. DEPARTMENT OF HUMAN SERVICES. REQUEST FOR EXEMPTION. (FROM CRIMINAL HISTORY RECORD ANDRead more
Analog Port Maximum 1600 x 1200 @ 75 Hz. Digital Port Maximum 1280 x 1024 dhs/topics/sbtopic015ccare.htm. . If you are a Home Office, Small, MediumRead more
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