Legal Criminal Record Declaration

LEGAL CRIMINAL RECORD DECLARATION

This Legal Criminal Record Declaration (the "Declaration") is made and entered into as of Effective Date: by and between Declarant Name: of Address: (hereinafter "Declarant"), and Recipient Name: of Address: (hereinafter "Recipient").

RECITALS

WHEREAS, the Recipient requires a written declaration from the Declarant regarding the existence or nonexistence of criminal convictions, pending charges, arrests, or other matters bearing on the Declarant's criminal history for the purposes set forth by the Recipient; and

WHEREAS, the Declarant acknowledges the obligation to disclose, in good faith and under penalty of perjury, all reportable criminal records as required by this Declaration and further consents to reasonable verification of such disclosures by the Recipient; and

WHEREAS, the parties wish to memorialize the Declarant's representations and the Recipient's rights with respect to use, retention, and verification of criminal history information;

NOW, THEREFORE, in consideration of the mutual covenants set forth herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Declaration: (a) "Conviction" means a plea of guilty, a plea of nolo contendere, a verdict of guilty, or a court-adjudicated finding of guilt; (b) "Pending Charge" means any criminal charge filed and not finally disposed of; (c) "Expunged or Sealed" means a criminal record that has been ordered by a court to be sealed or destroyed or otherwise not subject to public disclosure.

2. DECLARATION OF CRIMINAL HISTORY

The Declarant hereby declares the following with respect to their criminal record. The Declarant shall check the boxes that accurately describe their status and provide full written details where required.

Convicted of any felony in any jurisdiction within the past 20 years.

Convicted of any misdemeanor in any jurisdiction within the past 10 years.

Currently subject to any pending criminal charges.

Arrested but not convicted for any criminal offense that may be material to Recipient's assessment.

Records that have been expunged, sealed, or judicially modified.

3. DISCLOSURE DETAILS

If any box above is checked, provide a complete description below including nature of the offense, jurisdiction, docket or case number if available, date of arrest, date of disposition, sentencing, and any post-conviction relief or current status.

4. TIMEFRAME

The disclosures required by this Declaration cover the period beginning on: and continuing through the Effective Date set forth above.

5. AUTHORIZATION TO VERIFY

The Declarant authorizes the Recipient and its agents to make inquiries and obtain reports from courts, law enforcement agencies, background-screening services, and other entities to verify the accuracy and completeness of the Declarant's disclosures. This authorization includes obtaining copies of records, case dispositions, and any other relevant documentation.

6. USE, RETENTION, AND DISCLOSURE OF INFORMATION

The Recipient may use information obtained pursuant to this Declaration solely for legitimate business or regulatory purposes described to the Declarant at the time of request. The Recipient may retain copies of records as required by law or its records retention policies and may disclose such information to its affiliates, legal counsel, insurers, or as required by lawful process.

7. REPRESENTATIONS AND WARRANTIES

The Declarant represents and warrants that all statements made in this Declaration are true, complete and correct to the best of the Declarant's knowledge. The Declarant acknowledges that materially false or knowingly omitted information may constitute grounds for disciplinary action, termination of any relationship with the Recipient, civil liability, or criminal prosecution under applicable law.

8. INDEMNIFICATION

The Declarant agrees to indemnify, defend, and hold harmless the Recipient and its officers, directors, employees and agents from and against any and all claims, liabilities, losses, damages, costs and expenses (including reasonable attorneys' fees) arising out of or resulting from any false statement, omission, or breach of this Declaration by the Declarant.

9. CONFIDENTIALITY

Except as required by law, the Recipient shall treat the Declarant's reported information as confidential and shall not disclose it to third parties except as permitted in Section 6. The Recipient may disclose information when required by lawful process or to fulfill its obligations to regulators or other authorized third parties.

10. NOTICES

All notices under this Declaration shall be in writing and delivered to the addresses set forth below or to such other address as a party designates in writing pursuant to this Section.

11. GOVERNING LAW

This Declaration shall be governed by and construed in accordance with the laws of the State of without regard to conflict of laws principles. The parties submit to the exclusive jurisdiction of the state and federal courts located in that State for resolution of disputes arising under this Declaration.

12. ENTIRE AGREEMENT

This Declaration constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether written or oral.

13. SEVERABILITY

If any provision of this Declaration is held to be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby, and the parties shall negotiate in good faith to replace the invalid provision with a valid provision that achieves, to the extent possible, the original economic and legal intent.

14. AMENDMENT; WAIVER; COUNTERPARTS

No amendment or waiver of any provision of this Declaration shall be effective unless in writing and signed by both parties. No waiver shall be deemed a waiver of any subsequent breach. This Declaration may be executed in counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument.

15. CERTIFICATION

The Declarant certifies under penalty of perjury under the laws of the governing jurisdiction selected above that the foregoing is true and correct. The Declarant understands that knowingly making a false statement on this Declaration may subject the Declarant to civil or criminal penalties.

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