Sworn Statement 宣誓聲明 I acknowledge and agree to the following. 本人特此確認及同意以下內容: 1. I confirm that I have not been found guilty of patient or resident abuse. 本人確認,本人未曾被判定對病人或住戶有虐待行為。 2. I confirm that I have not been convicted of any crime or violation, other than a traffic infraction. 本人確認,本人未曾被定罪或有違規行為,交通違規除外。 3. I understand that my temporary employment is contingent upon the successful completion of my background check. 本人明白,本人的臨時僱用狀態需以背景調查的成功完成為條件。 4. I understand that providing false or misleading information may result in the immediate termination of my temporary employment. 本人明瞭,提供虛假或誤導性信息可能導致本人的臨時聘用立即被終止。Background Check and Fingerprinting Consent 背景調查和指紋採集同意書 By signing below, I give consent for the background check and fingerprinting process to proceed. I understand that, upon providing my consent, Golden Touch will submit my information for the background check. Once a notification is received from the DOH system, I will be informed to schedule my fingerprint appointment. 背景調查及指紋採集同意書 通過在下方簽名,我同意進行背景調查和指紋採集程序。我了解,經我同意後,萬有護理公司將提交我的信息進行背景調查。一旦收到政府系統的通知,我將被通知安排指紋採集的預約。Name名字(必填) First Name (名) Last Name(姓) Aide Code 護理編號(必填)HiddenD.O.B生日(必填) MM slash DD slash YYYY Address地址(必填) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Signature簽名(必填)Date日期(必填) MM slash DD slash YYYY