COMPASS
Applicant’s Oath
NAME _____________________________________________________________________________________________________
Last First M.I Maiden
DATE OF BIRTH ________/_______/___________ SOCIAL SECURITY # ________/__________/_________
I do hereby attest, under penalty or perjury, that:
(1) _________ I HAVE NEVER BEEN convicted of a felony or misdemeanor
(This includes driving under the influence of alcohol or drugs or driving while alcohol impaired. Misdemeanor traffic offenses such as speeding or minor traffic offenses do not need to be included. ) **
OR
(2) __________ I HAVE BEEN convicted of a felony or misdemeanor
(This includes driving under the influence of alcohol or drugs or driving while alcohol impaired. Misdemeanor traffic offenses such as speeding or minor traffic offenses do not need to be included.)
** All convictions must be reported, this includes a deferred or suspended sentence
**A person deemed to have been convicted of committing a felony or misdemeanor if such person has been convicted under the laws of this state, any other state, the United States, or any territory subject to the jurisdiction of the United States of an unlawful act which, if committed within this state, would be a felony or misdemeanor.
**Convicted means a conviction by a jury or by a Court and shall include the forfeiture of any bail, bond, or other security deposited to secure appearance by a person charged with having committed a felony or misdemeanor, the payment of a fine, a plea, or nolo contender and the imposition of a deferred or suspended sentence by the court.
I hereby attest that all information on and with this oath is true and complete to the best of my knowledge. I understand that any intentional misrepresentation of facts may result in denial of certification and that falsification of statements on and with this attestation may be punishable by law and may be cause for termination from employment. I further affirm that the fingerprint card submitted contains my actual fingerprints.
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Signature of Applicant
(To be signed in the presence of a Notary Public)
SUBSCRIBED AND SWORN TO BEFORE ME THIS _______DAY OF ___________________ 20__________.
WITNESS MY HAND AND OFFICIAL SEAL
_______________________________________ My Commission expires: ________________
If you have been convicted of a felony or misdemeanor, please list all convictions, dates of convictions and the City, State and County in which you were convicted.
Conviction:___________________________________________________________________________________________
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Date of conviction __________________ City _______________________ State _______ County _____________
Conviction:___________________________________________________________________________________________
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Date of conviction __________________ City _______________________ State _______ County _____________
Conviction:___________________________________________________________________________________________
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Date of conviction __________________ City _______________________ State _______ County _____________
Conviction:___________________________________________________________________________________________
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Date of conviction __________________ City _______________________ State _______ County _____________
