#2. CRIMINAL DISCLOSURE 03-031.pdf
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- Attached to
- WATER SOFTENER SYSTEM
- Solicitation number
- PR2425842
- Issued by
- Adams County, Asotin County, Benton County, Chelan County, Clallam County, Clark County, Columbia County, Cowlitz County, Douglas County, Ferry County, Franklin County, Garfield County, Grant County, Grays Harbor County, Island County, Jefferson County, King County, Kitsap County, Kittitas County, Klickitat County, Lewis County, Lincoln County, Mason County, Okanogan County, Pacific County, Pend Oreille County, Pierce County, San Juan County, Skagit County, Skamania County, Snohomish County, Spokane County, Stevens County, Thurston County, Wahkiakum County, Walla Walla County, Whatcom County, Whitman County, Yakima County, Asotin City, Clarkston City, Clarkston Heights-Vineland CDP, West Clarkston-Highland CDP, Benton City, Chelan City, Chelan Falls CDP, Clallam Bay CDP, Lewisville CDP, Rock Island City, Pacific Beach CDP, Whidbey Island Station CDP, Mercer Island City, Pacific City, Bainbridge Island City, Kingston CDP, Kitsap Lake CDP, Kittitas City, Klickitat CDP, Okanogan City, Anderson Island CDP, Fort Lewis CDP, Fox Island CDP, Herron Island CDP, Ketron Island CDP, North Fort Lewis CDP, Raft Island CDP, Stevenson City, Hat Island CDP, Lake Stevens City, Snohomish City, Spokane City, Spokane Valley City, Puget Island CDP, Garfield Town, Yakima City, Washington
About this file
The document is a Criminal Disclosure form required by the Washington Department of Corrections for all employees, contract staff, and volunteers. The form requires the disclosure of all criminal convictions and gross misdemeanors, regardless of when they occurred, including suspended and deferred sentences, and juvenile convictions. Background checks will be conducted, and untruthful or misleading answers will result in rejection of the application or dismissal.
The related state and local contract opportunity is for a new water softener system at the Coyote Ridge Correctional Center in Connell, Washington. A mandatory site visit/walk-through is scheduled for October 4, 2024. The contract opportunity covers multiple counties and cities in Washington state, including Franklin, Grant, Grays Harbor, Chelan, and Yakima counties.
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Text version
DOC 03-031 (Rev. 03/04/22) Page 1 of 1 DOC 530.100, DOC 810.015
CRIMINAL DISCLOSURE
As a law enforcement agency, it is necessary that all Department of Corrections employees, contract staff, and volunteers be carefully screened. This information is required in order to maintain security and safeguard the confidentiality of Department information. Criminal history may not preclude your employment or service with the Department.
Print full name:
List all conviction(s)/gross misdemeanor(s) below. Do not include convictions vacated by the court and removed from the official record. Please indicate “None” below if there are no convictions.
Disclosure requirements are not limited to any time period and include suspended and/or deferred sentences, convictions by a Juvenile Court where the applicant was 15 years of age or older at the time of the offense, and incarcerations for felony offenses, gross misdemeanor offenses involving violence, and any offenses involving sexual misconduct.
Date Crime If incarcerated, give location and dates.
If not incarcerated, what disposition was made?
None If you have had a felony conviction, have you received a certificate of discharge, including all civil rights being restored?
N/A No Yes, date: Attach a copy of the certificate of discharge.
Do you have the right under the law to carry and use a firearm? No Yes
ACKNOWLEDGEMENT AND RELEASE
I understand that a background check will be conducted including, but not limited to, arrests and convictions, prior employment, and education. All answers and statements are true and complete to the best of my knowledge. I understand that, if hired, I will be fingerprinted and that untruthful or misleading answers or deliberate omissions will be cause for rejection of my application, removal of my name from eligible registers, or dismissal, if employed or acting as a contract staff or volunteer.
By completing and submitting this form, I am authorizing release of my information.
Signature Date
The contents of this document may be eligible for public disclosure. Social Security Numbers are considered confidential information and will be redacted in the event of such a request. This form is governed by Executive Order 16-01, RCW 42.56, and RCW 40.14.
Distribution: ORIGINAL - Personnel/Contract/Volunteer file
File details come from the government source that posted it. Updated .