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Employment Criminal Conviction Certification

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EMPLOYMENT CRIMINAL CONVICTION CERTIFICATION

WHEREAS

WHEREAS, Employer requires full and accurate disclosure of criminal convictions and related adjudications as part of its evaluation of an individual’s suitability for employment or continued employment in positions where public trust, safety, security, or fiduciary responsibility is implicated; and

WHEREAS, Applicant/Employee acknowledges that failure to disclose relevant conviction information, or providing false information, may constitute grounds for withdrawal of an offer, discipline, or termination, and may subject the Applicant/Employee to civil or criminal penalties to the extent permitted by law; and

WHEREAS, Employer will consider disclosed convictions in accordance with applicable law and Employer policy, and will maintain disclosed information in confidence consistent with this Certification and applicable law.

EMPLOYEE INFORMATION

Date of Birth:    Last 4 of SSN:

Date of Application / Hire:

CERTIFICATION AND DISCLOSURE

I certify, under penalty of law, that the information I provide in this Certification is true, complete, and accurate to the best of my knowledge. I understand that Employer may verify the information I provide and obtain criminal conviction records and other background information as permitted by applicable law.

Have you ever been convicted of a felony or misdemeanor, or are you currently charged with a criminal offense?

Yes    No    (Check only one)

Have any convictions been sealed, expunged, or pardoned?
Yes    No

AUTHORIZATION TO INVESTIGATE

I hereby authorize Employer, and its agents or representatives, to obtain criminal conviction records, court records, and other background information relevant to my employment application or ongoing employment status. I authorize any person, agency, or entity having such records to release them to Employer. I release such persons and entities from liability for providing such information.

I understand that Employer will consider the nature, gravity, and recency of any conviction(s) and any evidence of rehabilitation in making an employment decision. I further understand that nothing in this Certification obligates Employer to employ me or to retain my employment.

CONFIDENTIALITY

Information provided on this Certification and any records obtained pursuant to the authorization will be treated as confidential records by Employer and will be used and disclosed only as permitted by Employer policy and applicable law.

GOVERNING LAW

Governing State:    This Certification shall be governed by and construed in accordance with the laws of the state indicated above, without regard to its conflict of law principles.

ENTIRE AGREEMENT

This Certification constitutes the entire written agreement between the parties with respect to the matters addressed herein and supersedes all prior statements and understandings, whether oral or written, relating to criminal conviction disclosure for employment purposes.

I acknowledge that I have read and understood this Employment Criminal Conviction Certification and that I have had an opportunity to ask questions prior to signing. I further acknowledge that knowingly providing false information may result in withdrawal of an offer or termination of employment.

Employee Printed Name:

By:

Date:

Employer Representative Printed Name:

By:

Date:

Enter text✕
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What the Employment Criminal Conviction Certification Is

An Employment Criminal Conviction Certification is a standardized declaration used by employers to record whether a job applicant or employee has been convicted of criminal offenses that may affect employment eligibility. The document asks the individual to disclose convictions, provide dates and jurisdictions, and affirm the truthfulness of the statement under penalty of perjury where required. Employers use the certification to document applicant disclosures, support background-check decisions, and maintain personnel files in compliance with company policy and applicable law. The certification can be executed on paper or electronically and must be retained per recordkeeping rules.

Why this certification matters for employers

Employers gain a documented, auditable record of an applicant's criminal history disclosure, which supports consistent hiring decisions, demonstrates compliance with screening policies, and helps manage legal risk. Accurate certifications reduce liability and streamline background-check workflows.

Why this certification matters for employers

Who completes and reviews the certification

Human resources, hiring managers, background-check vendors, and compliance officers commonly use the Employment Criminal Conviction Certification when screening candidates or updating personnel records.

  • HR departments documenting disclosures for new hires and internal transfers.
  • Background-check providers receiving candidate authorization and disclosure information securely and electronically.
  • Legal and compliance teams reviewing records for regulatory or contract obligations.

Use these user roles to design routing, authentication, and retention policies that fit the organization's compliance and hiring practices.

Typical signers and their responsibilities

Hiring Manager

Reviews disclosed convictions in context of job duties, documents decision rationale, and ensures consistent application of company policy. Should coordinate with HR and legal when convictions may affect safety-sensitive roles or regulatory licensure, and retain records per retention rules.

Applicant

Provides truthful responses about prior convictions, supplies dates and jurisdictions, and signs to attest accuracy. Should disclose rehabilitation, expungement, or sealing orders where applicable and consent to background checks when required. Mismatches can delay hiring.

Security and compliance controls to expect

Encryption: TLS 1.2/1.3 in transit
At Rest Encryption: AES-256 encryption at rest
Certifications: SOC 2 Type II; ISO 27001
HIPAA: BAA required for PHI workflows
Audit Trail: Timestamps, IPs, action history
Access Controls: Role-based access and SSO

Key risks and possible penalties

False Disclosure: May trigger perjury charges
I-9 Consequences: Paperwork fines $281–$2,789
FCRA Violations: Civil penalties and damages
Disqualification Risk: Loss of employment opportunity
HIPAA Risk: Potential breach notification
Reputational Harm: Public disclosure risk

Common preparation mistakes to avoid

  • Incomplete dates or jurisdictions on the certification lead to ambiguous results and can delay or invalidate background-check matches.
  • Using initials instead of full legal name creates mismatch with government records and may trigger backup withholding or verification requests.
  • Failing to update certifications after expungement or sealing can wrongly bar candidates and create legal exposure for the employer.
  • Relying on unsigned or undated electronic copies without an adequate audit trail undermines enforceability under ESIGN and UETA.

Step-by-step completion and verification

Follow these steps to complete, authenticate, and retain the Employment Criminal Conviction Certification so it meets legal and HR recordkeeping requirements.

  • 01
    Prepare Form: Select correct version and review company policy.
  • 02
    Enter Details: Fill in full legal name, dates, and jurisdictions.
  • 03
    Sign and Date: Signer must sign and date in MM/DD/YYYY format.
  • 04
    Store Record: Retain per retention policy and attach audit trail.

How the eCompletion and verification workflow operates

This workflow shows how the certification moves from completion to verification and integration with background-check systems for HR review.

  • Upload Document: Sender uploads PDF or DOCX to eSignature platform.
  • Assign Signers: Add signer emails and define signing order if needed.
  • Authenticate Signer: Use email link, SMS code, or stronger ID verification.
  • Deliver Copies: Signed PDF and audit trail delivered to parties.

Key elements of a professional certification form

Core elements define the Employment Criminal Conviction Certification's structure, authentication, and compliance controls to ensure uniform disclosure, legal validity, and reliable recordkeeping for HR and legal teams.

Disclosure Section

A clear disclosure block requests conviction type, date, jurisdiction, and case number where available; includes space for explanations and rehabilitative information to give context for employer evaluation.

Affirmation

A signed affirmation attests to the accuracy of the disclosure; it should state penalties for false statements where law requires, and include signature and printed name fields.

Consent

Explicit consent authorizes the employer to run formal background checks and to verify court records; the consent block should reference the background vendor and scope of checks.

Privacy Notice

A privacy statement explains how conviction data will be stored, who may access it, and retention period; reference applicable privacy laws and provide contact for questions.

Authentication

Authentication options should be listed, including acceptable ID types, multi-factor methods, or eSignature provider settings that create an auditable identity trail for the signer and timestamping.

Recordkeeping

Include fields noting who received and reviewed disclosures, dates of secondary verification, and instructions for secure storage; audit trail metadata should be preserved for compliance audits.

Recommended eSignature workflow settings

Recommended eSignature workflow settings to collect, verify, and route the Employment Criminal Conviction Certification for review and storage.

Field Configuration
Authentication Method Email verification plus optional SMS two-factor
Signing Order Sequential routing: applicant, HR, legal
Audit Trail Enable timestamps, IPs, and action logs
Storage Location Encrypted cloud storage with role-based access

Technical and integration considerations

Confirm supported file formats, integrations, and signer authentication options before deploying the electronic Employment Criminal Conviction Certification workflow.

  • File Formats: PDF, DOCX, and native form imports
  • Integrations: Salesforce, NetSuite, Google Workspace
  • Authenticator Options: Email link, SMS code, SSO

Timing and deadlines to observe

Key timing and deadlines to handle certifications, background checks, and retention during the hiring lifecycle.

When to Provide the Certification:

Give certification when requested by employer or during onboarding

Background-Check Timing:

Obtain applicant consent before ordering criminal background checks

Update After Sealing/Expungement:

Applicant should update certification upon court order or employer notification

I-9 and Hiring Record Retention:

I-9 is separate; retain certification per personnel record rules

Responding to Requests:

Provide copies to legal or regulatory requests within reasonable timeframe

Key milestones from submission to storage

Milestone timeline from receipt to final storage for the certification and associated background-check process in hiring workflows.

01

Receive Application

Applicant submits certification and consent; HR logs receipt.

02

Order Background Check

Employer orders check after receiving consent and verifies scope.

03

Review Findings

HR and legal review convictions for job relevance and compliance.

04

Store Record

File signed certification, vendor report, and audit trail securely.

eSignature vendor pricing and feature snapshot

Comparing common eSignature vendors for completing and managing the certification, with signNow shown first for feature parity and pricing context.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently asked questions and solutions

Common questions about completing, authenticating, and storing the Employment Criminal Conviction Certification are addressed below to reduce errors and compliance risk.


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