Edit, Download, and Sign the Arrest/Conviction Report and Certification Form
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How do I fill this out?
To fill out this form, begin by entering your personal information. Next, indicate any arrests or convictions you may have. Lastly, review your submissions and certify the accuracy of your information.

How to fill out the Arrest/Conviction Report and Certification Form?
1
Provide your full legal name and date of birth.
2
Report any former names you have been identified by.
3
Indicate any reportable offenses you have been arrested or convicted of.
4
Check the box if you have never been arrested or convicted.
5
Sign and date the form to certify its accuracy.
Who needs the Arrest/Conviction Report and Certification Form?
1
Current school employees need to report any offenses for compliance.
2
Prospective employees must complete this form before employment.
3
Volunteers in educational settings may be required to submit this form.
4
Contractors or service providers working with schools may also need this form.
5
Individuals applying to work in child-related positions must disclose any reportable offenses.
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1
Open the PDF in the PrintFriendly editor.
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Select the text or fields you wish to edit.
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4
Review the edits for accuracy.
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Save the updated PDF to your device.

What are the instructions for submitting this form?
Submit this form by delivering it to your designated administrator or HR personnel. For online submissions, consult your school’s procedure for electronic forms. Ensure that the form is completed and signed; otherwise, it may be rendered invalid.
What are the important dates for this form in 2024 and 2025?
Please note that current employees are required to submit this form by December 27, 2011. New regulations may come into effect after this date. Check for any updates regarding submission deadlines in 2024 and 2025.

What is the purpose of this form?
The Arrest/Conviction Report Form serves to maintain safety within educational institutions. It is designed to collect information regarding any criminal history of employees or applicants. Ensuring that all personnel are screened helps to protect students and comply with legal requirements.

Tell me about this form and its components and fields line-by-line.

- 1. Full Legal Name: The complete name of the individual filling out the form.
- 2. Date of Birth: The birth date of the applicant for identification purposes.
- 3. Former Names: Any previous names used by the applicant.
- 4. Report of Arrest or Conviction: Check this box if there are any reportable offenses.
- 5. Details of Arrests or Convictions: Provide specifics about any offenses, including dates and locations.
- 6. Certification: A statement that certifies the accuracy of the information provided.
- 7. Date: The date when the form is being filled out.
- 8. Signature: The signature of the applicant certifying the truth of the information.
What happens if I fail to submit this form?
Failing to submit this form can result in disciplinary actions or delays in employment. It is crucial for compliance with the law regarding criminal history disclosures.
- Employment Prosecution: Failure to disclose can lead to legal repercussions in employment situations.
- School Policies: Non-compliance may violate school district policies.
- Student Safety: Inaccurate reporting jeopardizes student safety and well-being.
How do I know when to use this form?

- 1. Job Application: Complete this form when applying for a job at a school.
- 2. Employment Changes: Use the form if there are any changes in criminal history during employment.
- 3. Compliance Reporting: Necessary for all current employees to report any relevant legal issues.
Frequently Asked Questions
How do I report a conviction?
You can report a conviction by filling out the specified sections in the form regarding your offenses.
Can I edit this form online?
Yes, you can easily edit this form using PrintFriendly's PDF editor.
Is there a deadline for submitting this form?
The completed form should be submitted by December 27, 2011, for current employees.
How do I download the completed form?
After editing, you can download the completed form directly from PrintFriendly.
Can I share the form with someone else?
Absolutely, PrintFriendly allows you to share the edited PDF via email or a shareable link.
What if I have multiple convictions?
You can specify multiple convictions in the details section of the form.
Is it necessary to provide accurate information?
Yes, providing accurate information is critical to avoid legal prosecution.
Can I print the form after editing?
Yes, PrintFriendly provides a print option after you complete your edits.
What do I do if I’ve never been convicted?
Simply check the box indicating you have never been arrested or convicted.
What happens if I submit false information?
Submitting false information can lead to prosecution under state law.
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