• Section 7.36.F.1 - Professional Staff Certification and Credentialing Requirements

  • , being duly sworn, do hereby certify that I have never been convicted of or 

  • pursuant to a plea agreement committing, and am not now awaiting trial for committing, any of the following criminal offenses in the state of Arizona or similar offenses in any other jurisdiction, including a charge or conviction that has been vacated, set aside or expunged:

    • Sexual abuse of a minor
    • Incest
    • First- or second-degree murder
    • Kidnapping
    • Arson
    • Sexual Assault
    • Sexual Exploitation of a minor
    • Felony  offenses  involving  contributing  to the delinquency of a minor
    • Commercial sexual exploitation of a minor
    • Felony offenses involving sale, distribution, or transportation of, offer to sell, transport, or distribute, or conspiracy to sell, transport, or distribute Marijuana or dangerous or narcotic drugs
    • Felony offenses involving the possession or use of  marijuana, dangerous drugs or narcotic drugs

    • Misdemeanor offenses involving the Possession or use of marijuana or dangerous  drugs
    • Burglary in the first degree
    • Burglary in the second or third degree
    • Aggravated or armed robbery
    • Robbery
    • A dangerous crime against children as defined in A.RS.13-604.01
    • Child abuse
    • Sexual conduct with a minor
    • Molestation of a child
    • Manslaughter
    • Assault or Aggravated assault
    • Exploitation of minors involving drug offenses
  • Subscribed, sworn to, and acknowledged before me by

    ____________________________, this _____ day of _________________, 20__,

    in __________________________ County, Arizona.

    My Commission Expires: ___________________


                     Notary Public

  • Reference: Section 7.36, Form 7.36.F.1