Criminal Affidavit Draft

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Criminal Affidavit Draft

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Professional References (1 of 2)

Please provide a current or past Supervisor Reference and a Professional/Personal Reference. By providing this information you are agreeing to allow CES to contact the references listed before your interview.

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Additional Information

Professional References (2 of 2)

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Have you ever been employed by CES before?(Required)

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Do you know anyone who works for CES?(Required)

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If so, who?(Required)

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I certify that all answers given are true and correct. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.In the event of employment, I understand that false or misleading information provided by me in this application, supporting documents, or during my interviews may result in discharge. I understand that withholding relevant or material information may, also, result in discharge. Furthermore, I understand that I am required to abide by all policies, rules, and regulations, of the employer.

Criminal Affidavit

To the Applicant:

Cooperative Educational Services (CES) assigns its Ancillary staff to school districts, charters and participating entities throughout the State of New Mexico. Your position as an Ancillary staff member involves contact with the student populations at these locations, including direct, unsupervised access to children with various forms of disability.

In order for CES to employ you in this capacity, you must provide the information requested below. This information is presented before your interview. Upon a successful interview, CES will conduct a social security and HB 128 2021 background checks. Final employment offer is contingent upon the results of the background checks.

Additionally, as a part of employment with CES, the district, charter, or participating entity you are assigned to will request completion of an additional fingerprint background check.

Any misrepresentation or omission of fact may be grounds for disqualification, termination or discharge, regardless of when the misrepresentation or omission is discovered.

Being charged with or convicted of a crime or any affirmative answer provided by you on this affidavit is NOT AN AUTOMATIC BAR to employment. CES will consider the nature of any conviction or alleged criminal conduct underlying the affirmative response, the date of the alleged criminal conduct in question, your intervening conduct, and the relationship between the offense or alleged conduct underlying the affirmative response and the position for which you are applying.

The crimes referred to in this document include but are not limited to:

Abandonment or abuse of a child
Sexual abuse of a minor
Incest of a minor
Sexual assault of a minor
Sexual exploitation of a minor
Sexual exploitation of a minor by prostitution
Contributing to the delinquency of a minor
Enticement of a child
Trafficking controlled substances
Distributing controlled substances to a minor
Delivery to a minor of drug paraphernalia
A dangerous crime against a child or children
Criminal sexual contact of a minor
Molestation of a child
Criminal sexual penetration
Criminal sexual conduct
Indecent exposure
Aggravated indecent exposure
Aggravated assault or a minor
Murder
Manslaughter
Kidnapping
Arson
Burglary
Robbery
Sale, delivery, display of Sexually oriented material to minors
Prostitution
Patronizing prostitutes
Promoting prostitution
Accepting earnings of a prostitute
D.U.I./D.W.I
Embezzlement
Fraud
Assault and/or Battery
Aggravated indecent oriented material to minors

Certification

Name(Required)

First Last

Certification(Required)

I, (name above), in consideration of an Ancillary staff position with CES, certify that this document is true, accurate, and full disclosure of my criminal background history.

Criminal Affidavit Draft

Professional References (1 of 2)

Professional References (2 of 2)

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Criminal Affidavit

Certification

SECTION 1

SECTION 2

Signature

CES Office

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