MIME-Version: 1.0 Content-Location: file:///C:/58726594/CriminalHistoryAffidavit.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" MINE HILL TOWNSHIP BOARD OF EDUCATION

MINE HILL TOWNSHIP BOARD OF EDUCATION=

CRIMINAL HISTORY AFFIDAVIT

 

STATE OF NEW JERSEY=      )

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      SS:

COUN= TY OF MORRIS         )

 

I, ________________________= __, of full age and capacity and having been duly sworn by the undersigned authori= ty hereby depose and say:

1.  I have volunteered to provide the following service for Min= e Hill School District:   

     ________________= _______________________________(identify the nature of the

     volunteer work) during the 2008-2009 school year.

2.  I hereby affirm that I have not been convicted of any crime under the laws of this State

     or any similar laws of the United States or any other State.

3.  I understand that the Mine Hill Dis= trict will rely upon this affirmation in allowing me

     to perform the volunteer work outlined in Paragraph 1.

4.  I am aware that I am subject to civ= il and criminal penalties for providing false or

     misleading information in connection with this matter.

5.  I understand that the Mine Hill School District reserves the right= to verify the accuracy  

     of the information contained herein through the State Criminal History Review = Unit or   

     other similar entity.

 

 

____________________________________

Signature

 

 

Sworn to and subscribed

before me on this _________= ___ day

of ______________, ________= ____.

 

______________________________

A Notary Public of the              <= /span>   My<= /span> commission expires ______________.

State of New Jersey  = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            =

 

 

BOE Policy 9180<= /o:p>