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Criminal History Disclosure Form - WSU College of Nursing 2026
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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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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2016 | 4.9 Satisfied (23 Votes) |
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