Custodial Child

Harvard Partners, LLC

**** *** *** *

Seattle, WA 98112

425-***-****

Criminal History Disclosure Statement

I,, have never been;

1.Convicted of any crime against children or other person: Aggravated murder, first or second degree murder, first or second degree kidnaping; first, second, or third degree assault; first, second, or third degree assault of a child; first, second, or third degree rape; first, second, or third degree rape of a child; first or second degree robbery; first degree arson; first degree burglary; first or second degree manslaughter; first or second degree extortion; indecent liberties; incest; vehicular homicide; first degree promoting prostitution; communication with a minor; unlawful imprisonment; simple assault; sexual exploitation of minors; first or second degree criminal mistreatment; endangerment with a controlled substance; child abuse or neglect; first or second degree custodial interference; first or second degree custodial sexual misconduct; malicious harassment; first, second or third degree child molestation; first or second degree sexual misconduct with a minor; patronizing a juvenile prostitute; child abandonment; promoting pornography; selling or distributing erotic material to a minor; custodial assault; violation of child abuse restraining order; child buying or selling; prostitution; felony indecent exposure; criminal abandonment; or any of these crimes as they may be renamed in the future.

2.Convicted of crimes relating to financial exploitation if the victim was a vulnerable adult: a conviction for first, second, or third degree extortion; first, second, or third degree theft; first or second degree robbery; forgery; or any of these crimes as they may be renamed in the future.

3.Convicted of crimes related to drugs: relating to “drugs” means a conviction of a crime to manufacture, delivery, or possession with intent to manufacture or deliver a controlled substance.

4.Found in any dependency action to have sexually assaulted or exploited any minor or to have physically abused any minor.

5.Found by a court in domestic relations proceeding to have sexually abused or exploited any minor or to have physically abused any minor.

6.Found in any disciplinary board final decision to have sexually or physically abused or exploited any minor or developmentally disabled person or to have abused or financially exploited any vulnerable adult, or

7.Found by a court in a protection proceeding to have abused or financially exploited a vulnerable adult.

Employee signature: Date:

Contact this candidate