Appendix F Criminal Background Investigation CBI Application.pdf

The document is a Criminal Background Investigation (CBI) Application from the New Jersey Department of Health and Senior Services. It is a standardized form for individuals seeking certification as Certified Nurse Assistants (CNA), Personal Care Assistants (PCA), or Certified Assisted Living Administrators (CALA) in the state of New Jersey. The application is designed to conduct a comprehensive background check for healthcare professionals who will be working with vulnerable populations such as the elderly or infirm.

The application requires detailed personal information and mandates disclosure of any criminal history that could potentially disqualify an applicant from certification. Specific disqualifying offenses include a wide range of serious crimes across multiple chapters, such as murder, assault, kidnapping, sexual offenses, robbery, larceny, and offenses involving child or elder abuse. Applicants with a criminal record may request a determination of rehabilitation, which requires submitting extensive documentation including personal statements, court records, proof of compliance with probation, drug counseling records, and statements of support. The process is rigorous, with permanent disqualification possible for certain serious offenses, and the application must be notarized and submitted to the Criminal Investigation Unit in Trenton, New Jersey.