Personal Background Affidavit Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Personal Background Affidavit Form. This is a California form and can be use in Board Of Pharmacy Statewide.
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Tags: Personal Background Affidavit, 17A-37, California Statewide, Board Of Pharmacy
American LegalNet, Inc. www.FormsWorkFlow.com 226 American LegalNet, Inc. www.FormsWorkFlow.com No224 This includes any felony or misdemeanor offense and any infraction. You must disclose a conviction even if it was: (1) later dismissed or expunged pursuant to Penal Code section 1203.4 or an equivalent release from penalties and disabilities provision from a non- California jurisdiction, or (2)later dismissed or expunged pursuant to Penal Code section 1210.1 or an equivalent post-conviction drug treatment diversion dismissal provision from a non-California jurisdiction. American LegalNet, Inc. www.FormsWorkFlow.com I hereby certify under penalty of perjury under the laws of the State of California to the truth and accuracy of all statements, answers, and representations made in the foregoing personal background affidavit, including all supplementary statements are true and accurate and that I personally completed this personal background affidavit. I understand that my application may be denied, or any license disciplined, for fraud or misrepresentation. American LegalNet, Inc. www.FormsWorkFlow.com