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Legal Criminal Convictions Declaration

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LEGAL CRIMINAL CONVICTIONS DECLARATION

This Criminal Convictions Declaration ("Declaration") is made as of by and between Declarant Name: (Declarant) and Requesting Party Name: (Requesting Party).

RECITALS

WHEREAS, the Requesting Party requires a written declaration regarding the Declarant's criminal convictions for the purpose of evaluating eligibility for employment, contracting, licensing or other legal relationship between the Parties; and

WHEREAS, the Declarant represents that the following statement of convictions, if any, is true, complete and correct to the best of the Declarant's knowledge and that the Requesting Party is relying on such statements in making determinations regarding the Declarant's suitability; and

WHEREAS, the Parties desire to set forth the terms concerning the disclosure, verification and consequences of disclosure or non-disclosure of criminal convictions.

NOW, THEREFORE, in consideration of the mutual promises contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the Parties agree as follows:

1. DEFINITIONS

For purposes of this Declaration: "Conviction" means any plea of guilty or nolo contendere, finding of guilt by a judge or jury, or a deferred adjudication that has not been expunged or sealed. "Relevant Conviction" means a Conviction that is not legally expunged or sealed and that occurred within the timeframe required by this Declaration or that is otherwise material to the Requesting Party's determination.

2. DECLARATION OF CONVICTIONS

The Declarant hereby certifies the truth of the following selection (check one) and, if applicable, provides details in Section 3 below:

I hereby declare that I have no criminal convictions that are not expunged or sealed and that would be required to be disclosed under this Declaration.

I hereby declare that I have one or more criminal convictions that are not expunged or sealed. I have provided full details of each such conviction in Section 3 below.

3. DETAILS OF CONVICTIONS

Provide complete information for each conviction. If additional space is required, attach a signed continuation sheet and mark as Attachment A.

If additional convictions exist, attach a signed continuation sheet labeled Attachment A and initial here:

4. SCOPE AND TIMEFRAME

Unless otherwise required by law or by written instruction from the Requesting Party, the Declarant shall disclose all convictions that are not expunged or sealed and that occurred within the following timeframe: . Convictions that have been judicially expunged or sealed need not be disclosed.

5. ONGOING DUTY TO DISCLOSE

The Declarant warrants that, during the term of any engagement with the Requesting Party, the Declarant will promptly notify the Requesting Party in writing of any new Conviction not previously disclosed. Such notice must be provided no later than after the final disposition of the matter.

6. AUTHORIZATION AND VERIFICATION

The Declarant authorizes the Requesting Party and its agents to verify the accuracy of the information provided herein, to obtain criminal history and court records, and to contact courts, law enforcement agencies and other appropriate entities for verification. The Declarant hereby releases those entities from liability for furnishing such information.

Declarant authorizes criminal history and background checks as described above.

7. REPRESENTATIONS; CERTIFICATION

The Declarant represents and warrants that all statements made in this Declaration are complete and true. The Declarant understands that making a materially false statement, omission or misrepresentation in this Declaration may constitute grounds for denial of an application, withdrawal of an offer, termination of employment or contract, or other lawful remedies available to the Requesting Party.

The Declarant certifies under penalty of perjury under the laws of the governing jurisdiction that the information provided in this Declaration is true and correct to the best of the Declarant's knowledge.

Certification checkbox: I certify under penalty of perjury that the foregoing is true and correct.

8. EFFECTS OF NON-DISCLOSURE; REMEDIES

The Requesting Party may take any lawful action in response to a material omission or misstatement, including rescission of any offer, termination of any agreement, forfeiture of benefits, or other remedies. The Requesting Party's election of any particular remedy shall not preclude pursuit of other remedies to which it is entitled at law or equity.

9. NOTICES

All notices required or permitted under this Declaration shall be in writing and delivered to the addresses below (or to such other address as a Party may designate by written notice to the other Party). Notices shall be deemed given upon personal delivery, courier delivery, or three business days after deposit in the mail.

10. MISCELLANEOUS

Governing Law: This Declaration shall be governed by and construed in accordance with the laws of the state specified here: , without regard to conflict of laws principles.

Entire Agreement: This Declaration constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior discussions, representations and agreements, whether written or oral.

Severability: If any provision of this Declaration is held invalid or unenforceable, the remaining provisions shall continue in full force and effect.

Amendments and Waiver: No amendment or waiver of any provision of this Declaration shall be effective unless in writing and signed by both Parties. A waiver by either Party of a breach shall not operate or be construed as a waiver of any other or subsequent breach.

Counterparts: This Declaration may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

Declarant Printed Name:

By:

Date:

Requesting Party Printed Name:

By:

Date:

Enter text✕

What the Legal Criminal Convictions Declaration Is

A Legal Criminal Convictions Declaration is a written statement by an individual disclosing past criminal convictions, pleas, or adjudications relevant to employment, licensure, contracting, or other regulated activities. It is commonly requested during hiring, background checks, professional licensing, and vendor onboarding to assess eligibility and public-safety considerations. The declaration typically identifies the nature of each conviction, relevant dates, jurisdiction, sentence or disposition, and any rehabilitation information. Because these disclosures touch on privacy and legal risk, many organizations pair the declaration with consent for background checks and specific retention and security safeguards under applicable U.S. law.

Why this Declaration Matters for Compliance and Risk

Using a clear, consistent declaration helps organizations evaluate risk, meet licensing or regulatory requirements, and make informed decisions while documenting the decision-making basis.

Why this Declaration Matters for Compliance and Risk

Who Typically Completes or Reviews the Declaration

The Legal Criminal Convictions Declaration is used across hiring, licensing, contracting, and compliance workflows; several groups interact with it directly.

  • Job applicants and employees who must disclose convictions as part of screening or ongoing employment policies.
  • Licensing applicants and regulated professionals responding to state or national licensing authorities.
  • HR, compliance, and hiring managers who review disclosures and apply policy consistently.

Organizations should limit access to disclosures, apply nondiscrimination policies, and document decisions to reduce legal risk while protecting sensitive personal data.

Primary Roles Involved

Hiring Manager

Responsible for requesting the declaration, evaluating disclosed convictions against policy, and documenting the hiring outcome. Must coordinate with HR and legal counsel when convictions could affect job responsibilities or licensure requirements.

Applicant

Provides accurate, complete information about convictions, including dates, jurisdictions, and dispositions. Should attach supporting court documents where requested and notify the requester if new information emerges after submission.

Core Elements of an Effective Declaration

Well‑designed declarations are concise, specific about required data, protect privacy, and include clear authentication and retention instructions.

Identification

Full legal name, date of birth, and government ID reference to match records and reduce misidentification in background checks.

Conviction Details

For each matter list the offense, jurisdiction, case number, disposition, sentence dates, and any completion or expungement information.

Context & Rehabilitation

Optional narrative field for applicants to explain circumstances, completion of programs, or evidence of rehabilitation when allowed by policy.

Consent & Authorization

Explicit consent for the employer or licensing body to verify disclosures and run criminal history checks where permitted by law.

Signature & Date

Signed declaration with clear date; electronic signatures are legally valid when ESIGN/UETA criteria are met.

Privacy Notice

Statement describing how the information will be used, who will see it, retention period, and contact for questions.

Stepwise Process to Complete and Submit the Declaration

Follow these key steps to provide a complete declaration and ensure prompt verification and appropriate handling by the requesting organization.

  • 01
    Gather Records: Collect court disposition documents and case identifiers before starting.
  • 02
    Complete Fields: Enter required data exactly, following MM/DD/YYYY and case number formats.
  • 03
    Authorize Checks: Sign the consent section if a background check is requested.
  • 04
    Submit & Retain: Upload supporting docs and keep a signed copy for your records.

Typical Workflow When an Organization Requests the Declaration

Most workflows combine an online form with optional verification steps and a secure retention policy.

  • Request: Organization issues request during application or onboarding.
  • Completion: Applicant fills fields and attaches records.
  • Verification: HR or vendor runs checks and compares records.
  • Decision: Organization applies policy and documents outcome.

Recommended Digital Workflow Settings

Configure form behavior and security to match the sensitivity of conviction data and the organization’s compliance obligations.

Field Configuration
Authentication Email + SMS OTP or stronger for high-risk roles
Required Attachments Enable PDF upload for disposition documents
Conditional Fields Show rehabilitation details only if conviction reported
Retention Policy Apply access limits and secure storage per legal retention rules

Technical and Integration Considerations

Secure handling and seamless routing reduce friction and preserve auditability when collecting sensitive conviction disclosures.

  • Integrations: Connect to HRIS, applicant tracking, and background-check vendors
  • Formats: Accept PDF, DOCX, and scanned images for supporting records
  • Security: Use TLS in transit and AES-256 at rest

Ensure the selected platform supports audit trails, configurable access controls, and the ability to attach and retain court dispositions securely.

Timing: When You Must Provide or Review the Declaration

Deadlines vary by context; the most common timing requirements are shown below to guide applicants and requesters.

Application Timeframe:

Provide the declaration with your initial application unless the request specifies otherwise

Pre-Employment:

Many employers require completion before a start date or background check initiation

Licensing:

State licensing boards typically require disclosure on application forms at submission

Update Obligation:

Notify the requester promptly if new convictions occur after submission

Retention Review:

Periodically review retained declarations per organizational retention policy

Key Milestones from Request to Final Decision

A typical milestone sequence ensures completeness, verification, and fair adjudication of disclosed convictions.

01

Request Issued

Organization requests disclosure and provides privacy notice.

02

Applicant Response

Applicant completes declaration and attaches records.

03

Verification Review

Background check and document verification are completed.

04

Final Determination

Decision is documented and retention begins.

How This Declaration Differs from Similar Documents

Compare the declaration to related forms used in hiring and licensing to understand scope, requirements, and whether notarization is typical.

Document Type Disclosure Required Notarization
Criminal Convictions Declaration sometimes
Background Check Consent
Employment Application sometimes
Professional License Application sometimes

Key Legal Risks and Potential Consequences

False Statements: Civil or criminal liability under 18 U.S.C. §1001 for knowingly false federal statements
Employment Action: Disciplinary action, withdrawal of offer, or termination
Licensing Sanctions: Denial, suspension, or revocation of professional license
Contract Forfeiture: Loss of contracting rights or termination for cause
Data Privacy: Improper handling may violate HIPAA or state privacy laws
Reputational Harm: Public disclosure can cause long-term career impact

Common Mistakes to Avoid When Preparing a Declaration

  • Omitting case numbers or court names, which delays verification and increases room for error
  • Using approximate dates instead of MM/DD/YYYY, causing mismatches in background searches
  • Failing to attach disposition documents or expungement records when requested, which may be treated as nondisclosure
  • Over-disclosure of irrelevant minor matters, increasing unnecessary privacy exposure

Practical Tips for Accurate and Efficient Completion

Apply consistent standard formats, document handling, and decision records to reduce disputes and processing delays.

Standardize Formats
Require MM/DD/YYYY for dates, full legal names, and a dedicated case‑number field to minimize mismatches during automated background checks and manual verification procedures.
Limit Access
Restrict disclosure viewing to HR and compliance personnel, log access events, and use role-based permissions to reduce unauthorized exposure of sensitive conviction data.
Attach Dispositions
Request official court dispositions or certificates of completion alongside the declaration so verifiers can confirm final outcomes and avoid treating incomplete records as unresolved convictions.
Document Decisions
Record the policy basis for adverse actions, include nondiscrimination considerations, and maintain a retention schedule aligned with legal requirements to support defensible decision-making.

Illustrative Use Cases

Two practical scenarios show how declarations are used and handled in common organizational workflows.

Small Employer Screening

An employer requests a declaration during final offer stage to assess suitability

  • HR verifies case numbers with a third-party vendor
  • The employer documents the review, applies policy uniformly, and stores the signed form in a secure HRIS with limited access.

Licensing Review

A state licensing board receives a declaration with attached dispositions

  • Board staff compare dispositions to statutory fitness criteria
  • If thresholds trigger concern, the board requests additional documentation and schedules a conditional review before determining eligibility.

FAQs: Common Questions About Declarations

Answers to frequent questions about completing, verifying, and handling a Legal Criminal Convictions Declaration in U.S. contexts.


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eSignature Pricing and Feature Comparison Relevant to This Declaration

Comparison of common eSignature vendors on starting price and key features that affect secure collection, notarization, and retention of sensitive declarations.

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