Acknowledgement of Clear Federal Record for Minors

For minors, ages 17 and under, please read the acknowledgment then check off, sign and have a legal parent/guardian co-sign affirming the following.

We affirm that I/my child are not disqualified from service under the grounds for denying employment and that I/they have not been convicted of an offense similar in nature to those crimes under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this commonwealth.

Date of Birth *

Email *

Employee Signature

First Name *

Last Name *

Parent/Guardian Signature