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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CRIMINAL RECORD STATEMENT Adoption Facilitator Persons submitting an
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How to fill out criminal record statement:

01
Begin by gathering all necessary information and documents such as personal identification, previous addresses, and any relevant court documents or police records.
02
Review the instructions provided for filling out the criminal record statement carefully to ensure that you understand each section and requirement.
03
Start with the personal information section, providing accurate details such as full name, date of birth, social security number, and contact information.
04
Proceed to the section where you will disclose your criminal history. Declare all convictions, arrests, or charges, providing specific details about each incident including dates, locations, and the nature of the offense.
05
If there are multiple offenses, ensure that you list them in a chronological order, starting from the oldest to the most recent.
06
Attach any supporting documentation such as court records or police reports for each incident declared.
07
Provide additional information if required, such as any rehabilitation or treatment received, or if the charges were dismissed or expunged.
08
Review the completed form thoroughly to ensure accuracy and completeness. Make sure all questions have been answered appropriately and legibly.
09
Sign and date the criminal record statement as required.
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Keep a copy of the completed form for your records.

Who needs a criminal record statement:

01
Individuals applying for certain job positions that require a background check, especially in fields such as law enforcement, education, healthcare, or finance.
02
Those seeking to immigrate or travel to certain countries which have strict visa requirements or security protocols.
03
Individuals facing legal proceedings or court appearances, as the criminal record statement may be required to be submitted as part of their case.
04
Students applying for certain educational programs that have strict admission criteria or require a criminal background check.
05
Anyone who is explicitly requested or required to submit a criminal record statement by a government agency, organization, or institution.
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The criminal record statement is a legal document that provides information about an individual's criminal history.
Individuals who are applying for certain positions, licenses, or permits may be required to file a criminal record statement.
To fill out a criminal record statement, you need to provide accurate and complete information about your criminal history, including any arrests, convictions, or pending charges.
The purpose of a criminal record statement is to allow employers, licensing agencies, or permit issuers to assess an individual's suitability for a position or privilege based on their criminal history.
A criminal record statement typically requires the reporting of any arrests, convictions, or pending charges, including dates, locations, and case numbers.
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Related Links

■ ■ ■ ■ ■ ■ ■ ■ OUT-OF-STATE DISCLOSURE & ...
State law requires that a person associated with licensed facilities or approved homes be fingerprinted, and disclose any conviction. A conviction is a plea ...
Forms and Publications (I-L)
... Criminal Record Statement · LIC 601 (8/08) - Identification And Emergency Information · LIC 602 (7/22) - Physician's Report For Community Care Facilities · LIC ...
CHAPTER 37 RIGHTS UPON RELEASE
your criminal record, they must give you a copy of the criminal record that they got from the police and give you an opportunity to dispute the accuracy or ...

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Relevant keywords

CALIFORNIA SSN LIC seq codified 508A DMV 1977 Respondents nformation licensee contendere nolo Adoptions discloses LICENSING Facilitator Caregiver EXEMPTION submitting Pursuant fingerprinted certify offenses attachments accompanying legislation II Registry

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