I.C.U Exceed Disqualifying Offenses

The following offenses are either permanently disqualifying or temporarily disqualifying when working with people with disabilities. By checking each box and signing below, you attest that you have not been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of these offenses. You agree that you will notify your employer within 14 days of being formally charged , convicted of, pleading guilty to, or found eligible for intervention in lieu of conviction for any of these disqualifying offenses and understand that failure to make this notification may result in termination of employment.