Can this disclosure be signed electronically?

Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the transaction meets intent, consent, attribution, and record retention tests. Maintain an audit trail with timestamp, IP, and signer attribution for evidentiary support.

Is notarization required for the disclosure?

Generally no. Employment criminal disclosures are internal HR records and typically do not require notarization. If a contract, licensing authority, or specific statute demands notarization or sworn affidavits, follow local notary rules and retain the notarized copy.

How should sealed or expunged convictions be handled?

Respect sealing and expungement orders. Do not rely on or request sealed records where state law prohibits disclosure or employer action. Consult counsel and your background vendor to confirm whether a record is legally removable from consideration.

How long must signed disclosures be retained?

Retain disclosures while employed and at least three years post-termination to align with common federal standards; if records include PHI, follow HIPAA six-year retention (45 CFR §164.530(j)). Adjust retention for state-specific rules.

What if an applicant disputes a reported conviction?

If an adverse action relied on a consumer report, follow FCRA dispute and notice procedures, allow vendor reinvestigation, and document all steps taken. If no consumer report was used, obtain additional verification and document the employer's review before taking adverse action.

How can employers minimize legal risk when using this disclosure?

Apply consistent timing, document individualized assessments and rationales, train decision-makers on EEOC guidance, secure records with access controls and audit logs, and seek legal review for complex adverse-action scenarios to support defensibility.

Electronic Signature
Templates
HR
Employment Criminal Convictions Disclosure

Employment Criminal Convictions Disclosure

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

EMPLOYMENT CRIMINAL CONVICTIONS DISCLOSURE

Purpose: This form collects information about criminal convictions and pending criminal proceedings for the purposes of evaluating suitability for employment or placement. Completion and signature are required as part of the application or personnel file. Providing incomplete, false, or misleading information may result in rejection of an application or termination of employment.

Personal Information

Full Legal Name Current Address

Phone

Email

Position Information

Position Applied For / Title Department / Hiring Manager

Desired Start Date:

Employment History (Most Recent First)

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 or Certification Institution Graduation Date

References

Reference 1 — Name Phone / Email / Relationship

Reference 2 — Name Phone / Email / Relationship

Reference 3 — Name Phone / Email / Relationship

Criminal Convictions

Have you ever been convicted of a crime (misdemeanor or felony), or entered a plea of guilty or nolo contendere to a criminal offense? Check one:

Yes No

If yes, provide complete details for each conviction below. Do not include arrests without convictions unless charges are pending.

Conviction Record 1 — Offense Description

Disposition / Sentence Case Number / Court Explanation / Additional Details

Conviction Record 2 — Offense Description

Disposition / Sentence Case Number / Court Explanation / Additional Details

Conviction Record 3 — Offense Description

Disposition / Sentence Case Number / Court Explanation / Additional Details

Pending Criminal Proceedings

Are there any pending criminal charges, indictments, or other unresolved matters currently outstanding against you?

Yes No

If yes, provide details

Legal Notices, Authorization, and Acknowledgement

Disclosure and Non-Discrimination: A criminal conviction does not automatically disqualify an applicant or employee. The company will consider the nature and gravity of the offense, the time since the offense, and the relevance to the duties of the position. The company complies with applicable laws prohibiting discrimination on the basis of arrest or conviction record where such protections apply.

Authorization to Investigate: I authorize the company and its agents to verify any information contained herein and to obtain any criminal history information, conviction records, and court documents that may be relevant to my application or employment. I authorize third parties, including law enforcement and judicial agencies, to release such information to the company upon request.

Sealed or Expunged Records: If a conviction has been sealed, expunged, or otherwise legally set aside, indicate so in the explanation section for that conviction. If state law prohibits inquiry into or consideration of certain records, provide accurate information to the extent required by law.

Applicant Acknowledgement: I certify that all information provided on this form is true, complete, and correct to the best of my knowledge. I understand that any omission or misstatement of material facts may be grounds for denial of employment or, if employed, disciplinary action including termination. I understand that this disclosure will be retained in my personnel file as permitted by law.

Applicant Certification

By signing below I affirm under penalty of perjury under applicable law that the information given on this form is true and correct. I consent to the release and review of my criminal history and related records for purposes of employment evaluation.

Applicant Name:

Signature:

Date:

What the Employment Criminal Convictions Disclosure Is and Why It Exists

The Employment Criminal Convictions Disclosure is a standardized document employers use during hiring, onboarding, or periodic reviews to obtain an applicant's or employee's statement about prior criminal convictions, adjudications, or pending charges. It requests specific dates, jurisdictions, case numbers when available, and brief factual context to enable accurate background checks. Employers keep the completed disclosure to document consistent screening practices, support individualized assessments required by EEOC guidance and state fair-chance statutes, and maintain an auditable record for compliance and internal decision-making.

Why a Clear Disclosure Matters for Hiring and Compliance

Collecting a clear disclosure creates consistent records for hiring decisions, reduces legal exposure by documenting individualized assessments, and helps employers comply with state 'ban-the-box' rules and EEOC guidance on the use of criminal history.

Who Typically Completes and Reviews This Disclosure

Employers, HR teams, and background-check vendors commonly use this disclosure in hiring, onboarding, and periodic eligibility reviews to capture consistent information.

Small and mid-size employers standardizing background screening and documenting hiring decisions.
HR managers conducting individualized assessments under EEOC guidance and state fair-chance laws.
Background-screening providers collecting uniform disclosures for reporting, verification, and compliance audits.

Nonprofits, contractors, and regulated employers often adapt the form to meet sector-specific obligations or contractual screening requirements.

Stepwise Process to Complete and Process the Disclosure

Follow these steps to complete and process the Employment Criminal Convictions Disclosure accurately and consistently.

01

Gather identification: Collect government ID and any case documents to verify names and dates.
02

Complete form: Enter required information in each field using MM/DD/YYYY for dates.
03

Sign and date: Signer must sign; use handwritten or verified electronic signature.
04

Store and retain: Store signed record per retention policy and legal requirements.

How the Disclosure Moves Through a Typical Hiring Workflow

Typical processing steps for collecting, verifying, and evaluating disclosed convictions in hiring workflows, including routing to HR and legal review.

Upload form: Sender uploads disclosure to the document system for processing.
Assign reviewers: Route to HR and compliance reviewers for evaluation.
Verify records: Background vendor confirms court records and matches entries.
Decision logged: Document individualized assessment, rationale, and final outcome.

Configuring a Secure Digital Workflow for Disclosures

Configure the digital workflow to ensure secure routing, signer authentication, and compliant retention of Employment Criminal Convictions Disclosures.

Workflow Setting and Configuration Details	Configuration options for each workflow step
Signer Authentication Method and Level	Email link, SMS code, or KBA as required
Routing and Approval Order Setup	Sequential routing: HR then legal reviewers
Retention and Record Export Settings	Archive as PDF/A with audit trail retained
Notifications and Reminders Schedule	Automatic email reminders after three days

Platform Features to Support Secure Collection and Storage

Choose a platform that supports secure e-signatures, detailed audit trails, and compliance with ESIGN and state electronic transaction laws.

Formats supported: PDF, Word DOCX, HTML
Integrations: Salesforce, Microsoft 365, NetSuite
Authentication options: Email, SMS, KBA, two-factor

eSignature Pricing and Feature Snapshot for Disclosure Workflows

Side-by-side vendor comparison of eSignature features relevant to Employment Criminal Convictions Disclosure processing, focusing on starting price and core compliance capabilities.

	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	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Security and Compliance Considerations for Stored Disclosures

Encryption: TLS 1.2/1.3 in transit

Data at rest: AES-256 encryption at rest

Certifications: SOC 2 Type II, ISO 27001

HIPAA: BAA required for PHI workflows

Legal acts: ESIGN and UETA compliance

Access controls: Role-based access and audit trail

Key Risks and Potential Penalties from Misuse or Errors

Discrimination claims: Potential EEOC enforcement and damages

False statements: Termination or legal liability

Data breaches: Regulatory fines and reputational harm

Recordkeeping violations: Penalties for missing or incomplete records

Incorrect denials: Wrongful rejection claims

State fines: Varies by jurisdiction

Common Preparation and Processing Pitfalls

Incomplete dates or missing court jurisdictions lead to unverifiable disclosures and delays in background checks, often requiring re-contact and candidate withdrawal.
Using nicknames, initials, or inconsistent name formats causes mismatches with criminal records and can trigger incorrect adverse decisions.
Failing to follow state fair-chance laws, such as delaying conviction questions until after a conditional offer where required, exposes employers to discrimination claims and fines.
Not documenting individualized assessments or decision rationale after disclosure increases litigation risk and undermines compliance with EEOC guidance.

Practical Steps to Reduce Risk and Improve Efficiency

Adopt consistent procedures, preserve robust audit trails, and train decision-makers to support defensible hiring decisions and compliance.

Standardize when disclosures are requested

Request disclosures at the same recruitment stage for all applicants for a given role, or after a conditional offer where required by state law; document timing to show consistent treatment if challenged.

Train HR on documented individualized assessments

Provide training so HR and hiring managers evaluate convictions based on job-relatedness, severity, and time elapsed; document factors considered and the rationale for adverse actions to align with EEOC guidance.

Limit access and secure records

Restrict disclosure access to authorized HR and compliance staff, encrypt stored files, log access events, and dispose records per retention schedules to reduce privacy and breach risks.

Use vetted background-check vendors with FCRA controls

Engage vendors that follow FCRA requirements, support record sealing and dispute resolution, and provide clear correction procedures to protect applicant rights and minimize errors.

How This Disclosure Differs from a Background-Check Authorization

A concise comparison highlights the different purposes and legal elements between a self-disclosure form and a vendor authorization used for third-party background checks.

Criteria	Employment Criminal Convictions Disclosure	Background Check Authorization
Primary purpose	self-disclosure	third-party report consent
Consent required		yes (fcra)
Typical timing	pre-offer or post-offer	prior to vendor run
Legal elements	applicant statement	fcra disclosures and dispute rights

Timing Guidelines and Processing Expectations

Key timing and processing expectations employers should follow when collecting, reviewing, and acting on disclosed convictions to comply with law and reduce delays.

When to request the disclosure:

State rules vary; many recommend asking after a conditional offer to align with fair-chance laws.

Timeline for employer review and decision:

Allow reasonable time for individualized assessment and vendor verification before adverse action.

Required adverse action notice period:

Follow FCRA procedures when a consumer report informs adverse action; provide required notices and timelines.

Record retention start date and duration:

Retention begins at signature; keep records per applicable federal and state timelines.

Expedited handling for regulatory roles:

Faster review recommended when positions affect public safety or require licensing.

Practical Examples of How Organizations Use the Disclosure

These examples illustrate real-world application of the Employment Criminal Convictions Disclosure across different organizational contexts and compliance needs.

Property Management

A regional property manager standardized its tenant and staff screening process using the disclosure across 150 listings.

The change improved documentation and consistency in decisions.
Documented disclosures enabled consistent denials based on objective criteria, reduced ad hoc decisions, provided defensible records during disputes, and simplified record retention and audit responses.

Community Health Clinic

A community health clinic implemented the disclosure alongside HIPAA staff authorizations to streamline background checks.

The integration supported safety and compliance.
Combining the disclosure with signed authorizations allowed the clinic to document decision rationale, limit access to disclosures, pass licensing inspections, and retain records per HIPAA's six-year rule.

Frequently Asked Questions and Troubleshooting Tips

Answers to common questions about completing, validating, and storing the Employment Criminal Convictions Disclosure, with practical troubleshooting guidance.

Need help? Contact support

Can this disclosure be signed electronically?
Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the transaction meets intent, consent, attribution, and record retention tests. Maintain an audit trail with timestamp, IP, and signer attribution for evidentiary support.
Is notarization required for the disclosure?
Generally no. Employment criminal disclosures are internal HR records and typically do not require notarization. If a contract, licensing authority, or specific statute demands notarization or sworn affidavits, follow local notary rules and retain the notarized copy.
How should sealed or expunged convictions be handled?
Respect sealing and expungement orders. Do not rely on or request sealed records where state law prohibits disclosure or employer action. Consult counsel and your background vendor to confirm whether a record is legally removable from consideration.
How long must signed disclosures be retained?
Retain disclosures while employed and at least three years post-termination to align with common federal standards; if records include PHI, follow HIPAA six-year retention (45 CFR §164.530(j)). Adjust retention for state-specific rules.
What if an applicant disputes a reported conviction?
If an adverse action relied on a consumer report, follow FCRA dispute and notice procedures, allow vendor reinvestigation, and document all steps taken. If no consumer report was used, obtain additional verification and document the employer's review before taking adverse action.
How can employers minimize legal risk when using this disclosure?
Apply consistent timing, document individualized assessments and rationales, train decision-makers on EEOC guidance, secure records with access controls and audit logs, and seek legal review for complex adverse-action scenarios to support defensibility.

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