Form Cc-201 - Certification Statement For Providing Child Care Services (Page 4 of 5) in pdf

CC-201 (8-14) - Page 4

Previous versions not accepted

Appealable Offenses

Are you awaiting trial for or have you ever been convicted of committing, attempting to commit, soliciting or facilitating or conspiring to

commit one or more of these crimes in this state or a similar crime in another jurisdiction? Mark “Yes” or “No” as applicable.

If you are awaiting trial on or been convicted of committing, attempting to commit, soliciting or facilitating or conspiring to commit one or

more of these crimes, DPS will deny you a Level 1 Fingerprint Clearance Card, but you will be eligible to appeal the decision to the Arizona

Board of Fingerprinting.

YES

1. Theft

2. Theft by extortion

3. Shoplifting

4. Forgery

5. Criminal possession of a forgery device

6. Obtaining a signature by deception

7. Criminal impersonation

8. Theft of a credit card or obtaining a credit card by fraudulent means

9. Receipt of anything of value obtained by fraudulent use of a credit card

10. Forgery of a credit card

11. Fraudulent use of a credit card

12. Possession of any machinery, plate or other contrivance or incomplete credit card

13. False statements as to financial condition or identity to obtain a credit card

14. Fraud by persons authorized to provide goods or services

15. Credit card transaction record theft

16. Misconduct involving weapons

17. Misconduct involving explosives

18. Depositing explosives

19. Misconduct involving simulated explosives

20. Concealed weapon violation

21. Misdemeanor indecent exposure

22. Misdemeanor public sexual indecency

23. Aggravated criminal damage

24. Adding poison or other harmful substance to food, drink or medicine

25. A criminal offense involving criminal trespass and burglary under Title 13, Chapter 15

26. A criminal offense involving organized crime or fraud as prescribed in Title 13, Chapter 23, except terrorism

27. Misdemeanor offenses involving child neglect

28. Misdemeanor offenses involving contributing to the delinquency of a minor

29. Misdemeanor offenses involving domestic violence as defined in A.R.S. § 13-3601

30. Felony offenses involving domestic violence if the offense only involved criminal damage in the amount of $250 but

less than $1000 and the offense was committed before June 29, 2009.

31. Arson

32. Criminal damage

33. Misappropriation of charter school monies as prescribed in A.R.S. § 13-1818

34. Taking identity of another person or entity

35. Aggravated taking identity of another person or entity

36. Trafficking in the identity of another person or entity

37. Cruelty to animals

38. Prostitution as described in A.R.S. § 13-3214

39. Sale or distribution of material harmful to minors through vending machines as prescribed in A.R.S. § 13-3513

40. Welfare fraud

41. Kidnapping

42. Robbery, aggravated robbery or armed robbery

43. Misdemeanor endangerment

Form Cc-201 - Certification Statement For Providing Child Care Services Page 4

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