R_-_DOJ_-_Certification_of_Employee_Background_Check_5.8.2025.pdf

CERTIFICATION OF EMPLOYEE BACKGROUND

Concerning Department of Justice (DOJ) Fingerprint and Criminal Background Investigation Requirements of Education Code (EC) Section 45125.1 et seq.

To: Wm. S. Hart Union High School District Vendor:

Attn: Contract Specialists Attn:

21380 Centre Pointe Parkway Address :

Santa Clarita, CA 91350 City, State, Zip Code:

Email: Email:

With respect to the Agreement Proposal dated between the Wm. S. Hart Union High School District (“District”) and the individual, company or contractor named above (“Vendor”) for provision of services.

Please check all appropriate boxes and sign below:

REQUIREMENTS SATISFIED

A) The Vendor certifies to the District that it has completed the criminal background check requirements of EC 45125.1 and that none of its employees that may come into contact with, or interact with, District students have been convicted of a felony.

ORI # _______________________

List or attach names of only those employees who have received official clearance following fingerprinting and criminal background check and for whom you provided the ORI# in the designated field.

Employee Employee Employee

WAIVER REQUEST

B) FOR CONSTRUCT ION OR REPAIR CONTRACTS ONLY . The Vendor seeks a waiver of the DOJ fingerprint & criminal background investigation permitted by EC section 45125.1. Vendor acknowledges that the District may approve or reject any waiver request in its sole discretion. Vendor and its employees will have more than LIMITED CONTACT with pupils but will ensure that one (1) or more of the following are utilized to protect pupil safety. [EC 45125.2(a)].

Check all methods to be used:

1) Installation of a physical barrier at the worksite to limit contact with students.

2) Continual supervision and monitoring of all employees of the Vendor by an employee of the Vendor, who has complied with EC section 45125.1(inclusive of having an ORI#):________________________________________ (Vendor employee name).

C) FOR ANY CONTRACT INCLUDING CONSTRUCTION OR REPAIR CONTRACTS.

1) Continuous surveillance of Vendor employees by an employee of the District:

_______________________________________ (District employee name).

2) The services provided by the Vendor are for an “emergency or exceptional situation” per EC 45125.1(b) or EC 45125.2(d).

I certify under penalty of perjury that the information contained in this Certification and any attachment is true and correct. I understand that it is Vendor’s sole responsibility to provide the District with any subsequent arrest and conviction information it receives throughout the duration of the contract between the District and Vendor.

Print or type name and title of CERTIFYING VENDOR AUTHORITY:

Signature of CERTIFYING VENDOR AUTHORITY:

Rev. 5/8/2025

Date: