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Driving while intoxicated and similar crimes are not considered minor traffic violations. If you are unsure whether to disclose a particular matter err on the side of disclosure. YES NO If yes list the crime s date s and location s city and state. Use the reverse side if additional space is needed. Applicant Name please print Applicant Signature Date // May 2016. A criminal history does not automatically disqualify you from employment with the Department of Health and Senior Services DHSS....
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