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Form 10 Rev. 3.2022PERSONAL/CRIMINAL HISTORY STATEMENTClear Forty or print clearly in dark ink. Complete all spaces or print N/A in spaces that do not apply. Name of ApplicantName of Business (if
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01
Obtain the necessary form for the personal criminal history statement.
02
Fill out all required personal information such as name, date of birth, address, and contact information.
03
Provide a detailed account of any criminal history, including dates, charges, and dispositions.
04
Include any relevant supporting documentation such as court records or police reports.
05
Review the completed form for accuracy and completeness before submitting it.

Who needs personalcriminal history statement?

01
Individuals applying for certain job positions that require a background check.
02
Individuals seeking to volunteer for organizations that work with vulnerable populations.
03
Individuals applying for certain licenses or permits, such as those in the healthcare or education fields.
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Personal Criminal History Statement is a document that outlines an individual's past criminal record.
Individuals who are applying for certain jobs or licenses may be required to file a Personal Criminal History Statement.
Individuals can fill out the Personal Criminal History Statement by providing accurate information about their past criminal record.
The purpose of the Personal Criminal History Statement is to allow employers or licensing agencies to conduct background checks on individuals before granting them certain opportunities.
Information such as past criminal convictions, arrests, and any sanctions imposed by courts must be reported on the Personal Criminal History Statement.
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