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

CC-201 (8-14) - Page 5

Previous versions not accepted

YES

44. Misdemeanor threatening or intimidating

45. Misdemeanor assault

46. Misdemeanor aggravated assault

47. Misdemeanor unlawfully administering intoxicating liquor, narcotic drugs or dangerous drugs

48. Misdemeanor dangerous or deadly assault by prisoner or juvenile

49. Misdemeanor prisoners who commit assault with intent to incite riot or participate in riot

50. Misdemeanor assault by vicious animals

51. Misdemeanor drive-by shooting

52. Misdemeanor assaults on public safety employees or volunteers and state hospital employees

53. Misdemeanor discharging a firearm at a structure

54. Misdemeanor prisoner assault with bodily fluids

55. Misdemeanor aiming a laser pointer at a peace officer

56. Misdemeanor possession and sale of peyote

57. Misdemeanor possession and sale of a vapor-releasing substance containing a toxic substance

58. Misdemeanor selling or giving nitrous oxide to underage persons

59. Misdemeanor sale of regulated chemicals

60. Misdemeanor sale of precursor chemicals

61. Misdemeanor production or transportation of marijuana

62. Misdemeanor possession, use or sale of marijuana, dangerous drugs or narcotic drugs

63. Misdemeanor possession, use, administration, acquisition, sale, manufacture or transportation of

prescription-only drugs

64. Misdemeanor administration, acquisition, manufacture or transportation of dangerous drugs or narcotic drugs

65. Misdemeanor manufacturing methamphetamine under circumstances that cause physical injury to a minor

under the age of 15

66. Misdemeanor involving or using minors in drug offenses

67. Misdemeanor 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

68. Misdemeanor possession, manufacture, delivery and advertisement of drug paraphernalia

69. Misdemeanor use of wire communication or electronic communication in drug-related transactions

70. Misdemeanor using a building for sale or manufacture of dangerous or narcotic drugs

71. Misdemeanor manufacture or distribution of prescription-only drug

72. Misdemeanor manufacture, distribution, or possession with intent to use imitation controlled substances, imitation

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

73. Misdemeanor manufacture of certain substances and drugs by certain means

The USDA is an equal opportunity provider and employer • DES/TANF Agencies are Equal Opportunity Employers/Programs • Under Titles VI and

VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act

of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department

prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age,

disability, genetics and retaliation. The Department must make a reasonable accommodation to allow a person with a disability to take part in a

program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a

wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to

take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to

understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To

request this document in alternative format or for further information about this policy, contact 602-542-4248; TTY/TDD Services: 7-1-1. • Free

language assistance for DES services is available upon request. • Disponible en español en línea o en la oficina local.