1. Convicted of a crime against children or other persons.

Aggravated murder; first or second degree murder; first or second degree kidnapping; first, second, or third degree assault; first, second, or third degree assault of a child; first, second, or third degree rape; first, second, or third degree rape of a child; first or second degree robbery; first degree arson; first degree burglary; first or second degree manslaughter; first or second degree extortion; indecent liberties; incest; vehicular homicide; first degree promotion prostitution; communication with a minor; unlawful imprisonment; simple assault; sexual exploitation of minors; first or second degree criminal mistreatment; child abuse or neglect as defined in RCW 26.44.020; first or second degree custodial interference; malicious harassment; first, second, or third degree child molestation; first or second degree sexual misconduct with a minor; patronizing a juvenile prostitute; child abandonment; promoting pornography; selling or distributing erotic material to a minor; custodial assault; violation of child abuse restraining order; child buying or selling; prostitution; felony indent exposure; criminal abandonment; or any of these crimes as they may be renamed in the future.

2. Convicted of crimes relating to financial exploitation if the victim was a vulnerable adult.

A conviction for first, second, or third degree extortion; first, second, or third degree theft; first or second degree robbery; forgery; or any of these crimes that may be renamed in the future. A vulnerable adult is an adult who lacks the functional, mental, or physical ability to care for themselves.

3. Convicted of crimes related to drugs;

A conviction of a crime to manufacture, deliver, or possession with intent to manufacture or deliver a controlled substance.

4. Found in any dependency action under RCW 13.34.040 to have sexually assaulted or exploited any minor or to have physically abused any minor; 

5. Found by a court in an domestic relations proceeding under Title 26 RCW to have sexually abused or exploited any minor or to have physically abused any minor; 

6. Found in any disciplinary board final decision to have sexually or physically abused or exploited any minor or developmentally disabled person or to have abused or financially exploited any vulnerable adult; 

Any final decision issued by a disciplining authority under RCW 18.130 or the Secretary of the Department of Health for the following businesses or professions: chiropractic, dentistry, dental hygiene, massage, midwifery, naturopathy, osteopathic medicine and surgery, physical therapy, physicians, practical nursing, registered nursing, and psychology. 

7. Found by a court in a protection proceeding under RCW 74.34, to have abused or financially exploited a vulnerable adult.

The illegal or improper use of a vulnerable adult or that adult’s resources for another person’s profit or advantage. 

DOH 505-055 June 2021

We require your legal name and birth date to obtain from the Washington State Patrol criminal identification system, a report of your record and criminal convictions for offenses against persons, civil adjudication’s of child abuse and disciplinary board final decisions. A thumbprint may be required to later verify information received from the State Patrol. We will make a copy of the report available to you upon your request.

UNDER PENALTY OF PERJURY, I certify that the above information is true, correct, and complete.  I understand that I can be barred and/or discharged from volunteering for any misrepresentation or omission in the above statements. I also understand that my volunteer status is conditioned on your receipt of a satisfactory report from the Washington State Patrol upon hire and every two years of volunteering with this organization.