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<br />ATTACHMENT III <br />FINGERPRINTING CERTIFICATION FORM <br /> <br />Differential Response <br />JANUARY 1, 2006 THROUGH JUNE 30, 2008 <br /> <br />A. <br /> <br />In accordance with the Child Abuse Prevention and Reporting section of this Agreement, <br />Contractor agrees as follows: Each applicant for employment or a volunteer position at <br />Contractor's program who will have a supervisory or disciplinary power over a minor or <br />any person under his or her care will be fingerprinted in order to determine whether they <br />have a criminal history which would compromise the safety of such minor(s) or person(s) <br />under his or her care. (Penal Code 111 05.3(a), as amended in 1990 by AB 2617). All <br />fingerprinting will be at Contractor's sole expense. <br /> <br />The fingerprinting process will be completed and the results of the process will be <br />obtained before any of Contractor's employees, subcontractors, assignees or volunteers <br />are assigned or permitted to work at the program. Alternatively, the Contractor may set a <br />hire date prior to obtaining fingerprinting results contingent on the applicant certifying <br />that: (1) his or her employment application truthfully and completely discloses whether he <br />or she has ever been convicted of a felony or misdemeanor or been on parole or <br />probation, and (2) that the applicant understands that a background check will be <br />conducted, and that he or she will be dismissed from employment immediately if he or <br />she has failed to provide information regarding convictions, has provided incomplete <br />information regarding convictions, has or omitted information regarding convictions, or if <br />the fingerprinting results reveal any conviction incompatible with this employment. <br /> <br />B. <br /> <br />C. <br /> <br />Contractor will maintain, and will make available to County upon request, a written <br />fingerprint certification for each applicant for employment or a volunteer position at the <br />program for whom fingerprinting is required. Such certification shall state that the <br />individual has been fingerprinted, that the process has disclosed no criminal history on <br />the part of the individual which would compromise the safety of persons with whom that <br />individual has contact. Fingerprint information received from the Department of Justice <br />(DOJ) will be retained or disposed of pursuant to DOJ directive. <br /> <br /><-PÎ1~ <br />c N me (Signa r) " ï/ ß Wz¿ <br /> <br />{ ,r <br />Title <br /> <br /> <br />1-;2 'f -OCt <br />Date <br /> <br />23 <br />