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DCS1078 (04/2024)ARIZONA DEPARTMENT OF CHILD SAFETYCRIMINAL HISTORY SELFDISCLOSURE AFFIDAVITYour fingerprints will be submitted to the Arizona Department of Public Safety (DPS) and the Federal Bureau
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How to fill out criminal history self-disclosure affidavit

01
Obtain the criminal history self-disclosure affidavit form from the appropriate authority or organization requesting it.
02
Fill out your personal information such as name, address, date of birth, and contact information on the form.
03
Provide details of any criminal convictions you have, including the date, charge, and outcome of the case.
04
Attach any supporting documents, such as court records or police reports, to the form if required.
05
Sign and date the form to certify that the information provided is true and accurate.

Who needs criminal history self-disclosure affidavit?

01
Individuals applying for certain jobs or licenses that require a criminal background check.
02
Applicants for housing or rental agreements that have a policy of conducting criminal background checks.
03
Students applying to educational institutions that require disclosure of criminal history.
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A criminal history self-disclosure affidavit is a legal document in which an individual provides a sworn statement regarding their criminal record, disclosing any past convictions, arrests, or legal issues.
Individuals applying for certain jobs, licenses, or educational programs, particularly in fields that require background checks, are typically required to file a criminal history self-disclosure affidavit.
To fill out a criminal history self-disclosure affidavit, you should obtain the form from the relevant authority, provide personal information, detail any criminal history accurately, sign the affidavit, and submit it according to the instructions provided.
The purpose of a criminal history self-disclosure affidavit is to ensure transparency in the hiring or licensing process by informing the employer or authority of any past criminal conduct that may impact eligibility.
Information that must be reported typically includes details of any arrests, convictions, the nature of the crimes, dates, and jurisdictions where the incidents occurred.
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