Criminal History

Signature needed below.

 

Federal policies (45 CFT Part 1301, Subpart D) Head Start Grants Administration, Personnel Policies, Section 1301.01 (c) and (d) now require that Head Start agencies required all prospective employees to sign a declaration prior to employment which lists:
  1.

 

2.

3.

All pending and prior criminal arrests and charges related to child sexual abuse and their disposition;

Convictions related to other forms of child abuse and/or neglect; and

All convictions of violent felonies.
  The declaration may exclude:
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 Any offense, other than any offense related to child abuse and/or child sexual abuse or violent felonies committed before the prospective employee's 18th birthday, which was finally adjudicated in a juvenile court or under a youth offender law;

Any conviction for which the record has been expunged under Federal or State law; and

Any conviction set aside under the Federal Youth Correction Act or similar State authority.

 
  Note that individuals who declare, through this form, that they have been arrested, charged with or convicted of any of the offenses listed above are not automatically disqualified from being hired. Head Start agencies must review each case to assess the relevance of an arrest, charge or conviction to a hiring decision.

Please provide your signature on the appropriate line below:
   

I have not been arrested, charged, and/or convicted on one or more of the three types of offenses listed above.

Signature:_________________________ Date_________
 

 

  

I  have been arrested, charged, and/or convicted on one or more of the three types of offenses listed above.

Signature:_________________________ Date_________
   

Head Start of Yamhill County will take necessary steps to ensure the confidentiality of this form.

 

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