Form Cc-201 - Certification Statement For Providing Child Care Services (Page 3 of 5) in pdf

CC-201 (8-14) - Page 3

Previous versions not accepted

Appealable 5 Years After Conviction

The following felony offenses are non-appealable if committed within 5 years of the date you apply for a Level 1 Fingerprint Clearance Card.

If you have been convicted of committing, attempting to commit, soliciting or facilitating or conspiring to commit one or more of the crimes

in this section within 5 years of applying for a Level 1 Fingerprint Clearance Card, DPS will deny you a Level 1 Fingerprint Clearance Card

and you WILL NOT be eligible to appeal the denial.

If the conviction was more than 5 years before you apply for a Level 1 Fingerprint Clearance Card, DPS will deny you a Level 1 Fingerprint

Clearance Card, but you will be eligible to appeal the denial to the Arizona Board of Fingerprinting.

Mark “Within 5 Years,” “Over 5 Years” or “No” as applicable.

WITHIN

OVER 5

5 YEARS

YEARS

1. Endangerment

2. Threatening or intimidating

3. Assault

4. Aggravated assault

5. Unlawfully administrating intoxicating liquors, narcotic drugs or dangerous drugs

6. Dangerous or deadly assault by prisoner or juvenile

7. Prisoners who commit assault with intent to incite to riot or participate in riot

8. Assault by vicious animals

9. Drive by shooting

10. Assaults on public safety employees or volunteers and state hospital employees

11. Discharging a firearm at a structure

12. Prisoner assault with bodily fluids

13. Aiming a laser pointer at a peace officer

14. Possession and sale of peyote

15. Possession and sale of a vapor-releasing substance containing a toxic substance

16. Selling or giving nitrous oxide to underage persons

17. Sale of regulated chemicals

18. Sale of precursor chemicals

19. Production or transportation of marijuana

20. Possession, use or sale of marijuana, dangerous drugs or narcotic drugs

21. Possession, use, administration, acquisition, sale, manufacture or transportation of prescription-only drugs

22. Administration, acquisition, manufacture or transportation of dangerous drugs or narcotic drugs

23. Manufacturing methamphetamine under circumstances that cause physical injury to a minor under the

age of 15

24. Involving or using minors in drug offenses

25. Possession, use, sale or transfer of marijuana, peyote, prescription drugs, dangerous drugs, or narcotic drugs

or manufacture of dangerous drugs in a drug-free school zone

26. Possession, manufacture, delivery and advertisement of drug paraphernalia

27. Use of wire communication or electronic communication in drug-related transactions

28. Using a building for sale or manufacture of dangerous or narcotic drugs

29. Manufacture or distribution of prescription-only drug

30. Manufacture, distribution, possession or possession with intent to use imitation controlled substances,

imitation prescription-only drugs or imitation over-the-counter drugs

31. Manufacture of certain substances and drugs by certain means

Form Cc-201 - Certification Statement For Providing Child Care Services Page 3

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