, have never been convicted of any of the following offenses under which would bar
1) 2)An offense under Section 20, Penal Code (kidnapping and false imprisonment) 3)An offense under Section 21.02, Penal Code (continuous sexual abuse of a young child or children) 4)An offense under Section 21.08, Penal Code (indecent exposure) 5)An offense under Section 21.11, Penal Code (indecency with a child) 6)An offense under Section 21.12, Penal Code (improper relationship between educator and student) 7)An offense under Section 21.15, Penal Code (improper photography or visual recording) 8)An offense under Section 22.011, Penal Code (sexual assault) 9)An offense under Section 22.02, Penal Code (aggravated assault) 10)An offense under Section 22.021, Penal Code (aggravated sexual assault) 11)An offense under Section 22.04, Penal Code (injury to a child, elderly individual or disabled individual) 12)An offense under Section 22.041, Penal Code (abandoning or endangering a child) 13)An offense under Section 22.05, Penal Code (deadly conduct) 14)An offense under Section 22.07, Penal Code (terroristic threat) 15)An offense under Section 22.08, Penal Code (aiding suicide) 16)An offense under Section 25.031, Penal Code (agreement to abduct from custody) 17)An offense under Section 25.08, Penal Code (sale or purchase of a child) 18)An offense under Section 28.02, Penal Code (arson) 19)An offense under Section 29.02, Penal Code (robbery) 20)An offense under Section 29.03, Penal Code (aggravated robbery) 21)An offense under Section 33.021, Penal Code (online solicitation of a minor) 22)An offense under Section 34.02, Penal Code (money laundering) 23)An offense under Section 35A.02, Penal Code (Medicaid fraud) 24)An offense under Section 36.06, Penal Code (obstruction or retaliation) 25)An offense under Section 37.12, Penal Code (false identification as peace officer) 26)An offense under Section, 42.01(a) (7), (8), or (9), Penal Code (disorderly conduct) 27)An offense under Section 42.09/42.092, Penal Code (cruelty to livestock animals or cruelty to non-livestock animals); or 28)Conviction under the laws of another state, federal law, or the Uniform Code of Military Justice for an offense containing the elements that are substantially similar to the elements of an offense listed.
An offense under Section 19, Penal Code (criminal homicide)
Neither have I been convicted of any of the following offenses which potentially may bar employment:
Assaultive Offenses (under Section 22.01) - Securing Execution of a Document by Deception (under Chapter 32.46) - Possession of Weapons - Felony Violation for the Possession or Distribution of a Controlled Substance - Disorderly Conduct (under Section 42.01) - Misapplication of Fiduciary Property or Property of a Financial Instrument (under Section 32.45)
- Burglary and Criminal Trespass (under Section 30.02) - Theft (under Chapter 31) - Public Indecency - Public Lewdness
I hereby allow A Fair Choice, Inc. to conduct a criminal record check in order to verify the above statement. Below is a space for me to inform A Fair Choice, Inc. of anything that will be on my record and to provide explanation:
The Texas Department of Aging & Disability Services maintains registries of individuals who have been found to have abused, neglected, or exploited a consumer, or misappropriated a consumer’s property. I have never been investigated by the Texas Department of Aging & Disability Services and found to have abused, neglected, or exploited a consumer, nor have I been found to have misappropriated a consumer’s property. A Fair Choice, Inc. is required by law to search the Employee Misconduct and Nurse Aides Registries before hiring an employee. A Fair Choice, Inc. is prohibited from employing a person who is listed in the registries as having abused, neglected, or exploited a consumer or misappropriated a consumer’s property.
, am not now, nor have I ever been recorded in the Employee Misconduct Registry (EMR), nor the Nurse Aides Registry (NAR) under Texas Health and Safety Code Section 253.007. I hereby allow A Fair Choice, Inc. to sear the EMR & NAR. I verify, also, that I have read and understand the company’s policy concerning client abuse. I further acknowledge and agree that my signature below will serve as my resignation if a criminal history check reveals any conviction for any of the above listed offenses which I have not revealed herein and/or if I am found to be listed in the EMR or NAR.