• Disclosure Statement

  • Disclosure Statement

    Due to issues of liability and as required by State Law (RCW 43.43), we need to ask the following questions. A "Yes" answer will not necessarily disqualify you from consideration for the position for which you have applied. This information will be kept confidential.
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  • Have you ever been found in any dependency* action to have sexually assaulted or exploited any minor or to have physically abused any minor?*
  • Have you ever been found in a court in a domestic relations proceeding (divorce, dissolution or custody action) to have physically abused or exploited any minor?*
  • Have you ever been found in any disciplinary board final decision to have sexually or physically abused or exploited any minor or developmentally disabled person?*
  • Have you ever been found in any disciplinary board final decision to have abused or financially exploited any persons 60 years or age or older who has a functional, mental or physical inability to care for him/herself or who is a patient in a state hospital?*
  • Have you ever been found by a court in a protection proceeding under Chapter 74.34 RCW to have abused or financially exploited a person 60 years of age or older who has a functional, mental or physical inability to care for him/herself or who is a patient in a state hospital?*

  • UNDER PENALTY OF PERJURY, I certify that the above information is true, correct and complete. I understand that if I am hired, I can be discharged for any misrepresentation or omission in the above statement. I also understand that if I am hired, my employment is conditioned on your receipt of a satisfactory report from the Washington State Patrol.

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  • We may request your fingerprints to obtain from the Washington State Patrol criminal identification system a report of your record of criminal convictions for offenses against persons, civil adjudications of child abuse, and disciplinary board final decisions. If you are hired before that report is available, YOUR EMPLOYMENT WILL BE CONDITIONED UPON THE RECEIPT OF A SATISFACTORY REPORT.

    You will be notified of the State Patrol's response within 10 days after we receive the report. We will make a copy of the report available to you upon your request.

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