Can this be signed electronically?

Yes. Electronic signatures that meet ESIGN and applicable state law are valid; ensure the platform captures intent, consent, attribution, and retention to meet legal requirements.

Do I need a notary or witness?

Most employment certifications do not require notarization, but some roles or jurisdictions may. Confirm internal policy and state rules before requesting notarization or witnesses.

What if the applicant disputes a background report?

Retain the signed certification and supporting details, then follow the background-check vendor’s dispute resolution process; document any employer follow-up or verification steps.

How long should signed forms be kept?

Keep signed certifications per retention policy: typically at least 3 years after termination; extend retention if tied to I-9, HIPAA, or other regulations.

How to handle sealed or expunged records?

If an applicant indicates an expunged or sealed conviction, request documentation and consult counsel about whether it must be considered under applicable law.

What authentication level is recommended?

Use email + SMS or knowledge-based authentication for most hires; require higher-strength methods for sensitive or regulated positions.

Electronic Signature
Templates
HR
Employment Criminal Convictions Certification

Employment Criminal Convictions Certification

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

EMPLOYMENT CRIMINAL CONVICTIONS CERTIFICATION

Personal Information

Full Name Address

Phone

Email

Date of Birth

Position Information

Position Applied For / Current Position

Department

Reporting Manager

Proposed / Current Start Date

Criminal Conviction Disclosure

Has the applicant or employee ever been convicted of a criminal offense, pled guilty or nolo contendere, or received a deferred adjudication, other than minor traffic infractions?

Yes No

If Yes, provide all convictions that have not been expunged, sealed, annulled or otherwise legally set aside. Include date, offense, jurisdiction, disposition and a brief factual explanation.

Conviction 1

Date: Offense: Jurisdiction:

Disposition:

Conviction 2

Date: Offense: Jurisdiction:

Disposition:

Conviction 3

Date: Offense: Jurisdiction:

Disposition:

Employment History (Most Recent)

Employer 1 - Company Name

Job Title

Dates Employed

Primary Responsibilities Reason for Leaving Employer 2 - Company Name

Job Title

Dates Employed

Primary Responsibilities Reason for Leaving

Education

Highest Degree / Certificate Institution Graduation Date

Professional References

Reference 1 Reference 2 Reference 3

Legal Disclosures and Authorization

I understand and acknowledge that the employer may conduct a criminal background check as a condition of employment or continued employment. I further understand that a criminal conviction does not automatically disqualify me; the employer will evaluate the nature of the offense, the time elapsed, and its relevance to the duties of the position.

I authorize the employer, its representatives and agents to contact prior employers, educational institutions, and references to verify the information provided. I authorize the release of records and information requested in connection with any criminal background check and employment investigation.

I authorize investigation and release of records as described above.

I consent to criminal background checks and verification of information.

Applicant Certification

I certify that all information provided on this form and in connection with my application is true, complete and correct to the best of my knowledge. I understand that omission, misstatement, or falsification of information may result in denial of employment, or if employed, discipline up to and including termination. I understand that I may be required to provide supporting documentation for any conviction disclosed herein.

By signing below I acknowledge that I have read, understand, and agree to the statements and authorizations contained in this document.

Printed Name:

Signature:

Date:

What the Employment Criminal Convictions Certification Is

The Employment Criminal Convictions Certification is a written statement used by employers or hiring entities to document a candidate’s disclosures regarding criminal convictions, pending charges, or related adjudications. It can be a standalone form or part of an application package and typically asks the applicant to affirm the truth of prior criminal history, provide dates and jurisdictions, and consent to background checks. When used electronically, the certification must meet U.S. e-signature standards (ESIGN and applicable state law) to be enforceable and retained as a reproducible record.

Why this Certification Matters for Hiring Compliance

A clear certification helps employers document candidate disclosures, satisfy internal hiring policies, and support lawful background checks while reducing later disputes about what was reported.

Who Typically Completes or Receives This Certification

Employers, HR teams, and background-screening providers use the certification to gather applicant disclosures before or during hiring.

HR teams and recruiters screening applicants for sensitive roles or regulatory requirements.
Background-check vendors integrating applicant answers with criminal-record searches.
Hiring managers for positions requiring security clearances, financial trust, or work with vulnerable populations.

Using a standard form improves consistency across hires and creates a defensible, retained record of the applicant’s own sworn responses.

Core Elements of a Professional Certification Form

A well-structured Employment Criminal Convictions Certification balances clarity for the signer with the employer’s need for reliable information, while enabling lawful electronic completion and retention.

Identification

Full legal name, date of birth, and contact information to match background-search records.

Disclosure Questions

Clear, time-limited questions about convictions, plea agreements, deferred adjudication, or pending charges.

Explanation Field

Space for applicant to provide context, jurisdictions, case numbers, and disposition dates.

Consent

Explicit consent for criminal background checks and release language required by screeners.

Attestation

A sworn statement that responses are true and complete under penalty of perjury or company policy.

Signature Block

Signature, printed name, and date field designed for eSignature or wet-signature and retention.

Required Data Fields at a Glance

Full Name: Given name and surname

Date of Birth: MM/DD/YYYY format

Disclosure Period: Timeframe for convictions

Jurisdiction: State or federal court

Case Details: Charge and disposition

Signature: Signed and dated

Step-by-Step: Completing the Certification

Follow these sequential steps to complete and submit the Employment Criminal Convictions Certification accurately.

01

Gather IDs: Collect government ID and case records
02

Answer Questions: Respond truthfully to disclosure items
03

Provide Details: Enter jurisdiction, case number, disposition
04

Sign and Submit: Sign electronically or wet-sign and return

How Electronic Submission Typically Works

Electronic workflows streamline collection while preserving an audit trail; here are the core actions in an eSubmission flow.

Upload Form: Employer uploads PDF or template
Assign Fields: Place signature and disclosure fields
Notify Signer: Send secure email or link
Capture Audit Trail: Record timestamps, IP, and actions

Configuring an Online Certification Workflow

Recommended field settings and authentication for reliable eCollection and later verification.

Field	Configuration
Signature Field	Required; captures timestamp and signer IP
Date Field	Auto-fill option; MM/DD/YYYY
Identity Check	Email + SMS code or KBA if required
Retention Policy	Set to preserve audit trail and PDF

Technical Considerations for eSubmission

Choose a platform that supports secure eSignature, audit trails, and the authentication level your organization requires.

Formats: PDF and DOCX supported
Integrations: Connects to HRIS and ATS
Security: TLS 1.2/1.3 and AES-256

Ensure the vendor supports ESIGN/UETA compliance, optional two-factor signer authentication, and straightforward export of signed records for long-term retention.

Typical eSignature Pricing and Feature Comparison

Common vendor pricing and feature availability for organizations collecting Employment Criminal Convictions Certifications electronically.

	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	Yes	Yes	Yes	Yes
Bulk Send	Yes (Business Premium)	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Penalties and Risks of Incorrect or Incomplete Certifications

Employment Liability: Discrimination or wrongful-termination claims

Recordkeeping Penalties: Fines for I-9 or labor violations

Background Mismatch: Delays or rescinded offers

Fraud Risk: False statements may carry legal consequences

Data Privacy: Unauthorized disclosure of sensitive data

Reputational Harm: Public exposure of noncompliance

Common Mistakes to Avoid When Preparing the Form

Using vague timeframes that do not match background-check vendor requirements, causing incomplete search results and disputes.
Failing to collect full jurisdiction or case identifiers, which prevents accurate record matching and delays hiring decisions.
Omitting explicit consent for background checks in jurisdictions that require written authorization, leading to legal challenges.
Not retaining an auditable copy of the signed record, which undermines defensibility in disputes or regulatory reviews.

Practical Tips for Accurate and Efficient Collection

Adopt consistent templates and an auditable eSignature workflow to reduce errors and simplify retention.

Standardize Questions

Use precise, time-bound disclosure questions to match background-check criteria and reduce ambiguity.

Require Supporting Details

Ask for jurisdiction, case number, and disposition to speed verification and reduce follow-up.

Set Authentication

Use email + SMS or KBA for higher-risk roles to strengthen attribution.

Preserve Audit Trails

Keep signed PDFs with timestamps, IP addresses, and signer authentication records for defensibility.

Industry Examples of Use

Real-world scenarios where a certification is commonly used and how it fits into hiring workflows.

Healthcare Hiring

Hospitals require disclosures for staff working with patients

Verification is linked to credentialing checks
Retain signed records for 6 years when PHI is involved and follow HIPAA rules.

Financial Services

Banks screen for convictions affecting fiduciary trust

Certifications feed into enhanced background investigations
Maintain records to support licensing and regulatory audits.

Frequently Asked Questions and Troubleshooting

Answers to common questions about completing, signing, and storing the Employment Criminal Convictions Certification.

Need help? Contact support

Can this be signed electronically?
Yes. Electronic signatures that meet ESIGN and applicable state law are valid; ensure the platform captures intent, consent, attribution, and retention to meet legal requirements.
Do I need a notary or witness?
Most employment certifications do not require notarization, but some roles or jurisdictions may. Confirm internal policy and state rules before requesting notarization or witnesses.
What if the applicant disputes a background report?
Retain the signed certification and supporting details, then follow the background-check vendor’s dispute resolution process; document any employer follow-up or verification steps.
How long should signed forms be kept?
Keep signed certifications per retention policy: typically at least 3 years after termination; extend retention if tied to I-9, HIPAA, or other regulations.
How to handle sealed or expunged records?
If an applicant indicates an expunged or sealed conviction, request documentation and consult counsel about whether it must be considered under applicable law.
What authentication level is recommended?
Use email + SMS or knowledge-based authentication for most hires; require higher-strength methods for sensitive or regulated positions.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now