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Click ‘Get Form’ to open the Criminal History Disclosure Form in the editor.
Begin by filling out your personal information at the top of the form, including your full name and contact details.
Proceed to Section A, where you will indicate if you have ever been charged or convicted of any listed crimes against persons. Check all that apply and provide detailed information in Section G.
In Section B, answer whether you have been found in any judicial or administrative proceedings related to domestic violence or abuse. Again, provide details in Section G if applicable.
Continue through Sections C, D, and E regarding drug-related crimes, Medicare/Medicaid-related crimes, and healthcare licensure issues. Ensure you check 'Yes' or 'No' as required.
In Section F, disclose any other convictions within the past 10 years. If applicable, list conviction dates and nature of offenses.
Finally, review your answers for accuracy before signing the acknowledgment statement at the bottom of the form.

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How to get your criminal record in Washington state?

You may inspect your criminal history record at the Washington State Patrol Office in Olympia. To make an appointment, call 360-634-2000. The Washington State Patrol may require you to submit fingerprints for identification, and may charge $13 for fingerprinting.

Can employers ask about criminal history in Washington state?

(1) An employer may not include any question on any application for employment, inquire either orally or in writing, receive information through a criminal history background check, or otherwise obtain information about an applicants criminal record until after the employer initially determines that the applicant is

What disqualifies you from being a CNA in Maryland?

Maryland Code Section 8-6A-10(a) s next grounds for discipline are when a CNA is disciplined by a licensing, military, or disciplinary authority or convicted or disciplined by a court for an act that would be grounds for disciplinary action under the Boards disciplinary statutes, or is convicted of or pleads

How far back does the board of nursing background check go?

Depending on where the candidate lives, the record may only include a candidates criminal history for the last seven years. In others, there may be no reporting time limit. How far back a background check goes depends on the state.