22VAC40-191-110: Describing the contents of a waiver application

A. The waiver application is a personally prepared application.

B. The waiver application must be submitted in typewritten form or neatly printed and include:

1. A statement that the request was solely and personally prepared by the requester and has not been edited or changed by anyone else. The document may be typed by another person;

2. A statement that the requester understands that the waiver will be available for inspection by the public and that the facility will provide a copy of the waiver to every parent and guardian if the waiver is granted;

3. A statement that the requester understands that information in the waiver application package will be made available by the commissioner to any person upon request if the waiver is granted;

4. Personal and employment information;

5. A factual account of the crime of the person with the disqualifying conviction;

6. The current status and history with justice systems of the person with the disqualifying conviction;

7. Other information the person with the disqualifying background wants the commissioner to consider in evaluating the waiver request;

8. An explanation of why the waiver should be granted; and

9. Seven attachments:

a. A nonrefundable check, made payable to the "Treasurer of Virginia," for waiver application processing;

b. For the person with the disqualifying conviction:

(1) A "Current Employment and Employment History Form";

(2) A copy of the current sworn statement or affirmation;

(3) A copy of the current criminal history record report;

(4) A copy of all necessary documents verifying the person's statements regarding past and current involvement with adult or juvenile justice systems within or outside the Commonwealth;

(5) At least four references by disinterested individuals who will vouch for the "good moral character and reputation" of the person with the disqualifying conviction;

(6) The Sponsoring Agency Statement; and

(7) A notarized signature page.