Virginia Administrative Code
Title 22 - SOCIAL SERVICES
Agency 40 - DEPARTMENT OF SOCIAL SERVICES
Chapter 191 - BACKGROUND CHECKS FOR WELFARE AGENCIES
Section 22VAC40-191-110 - Describing the contents of a waiver application

Universal Citation: 2 VA Admin Code 40-191-110

Current through Register Vol. 41, No. 3, September 23, 2024

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.

Statutory Authority: §§ 63.2-217. 63.2-1732, 63.2-1733, and 63.2-1734 of the Code of Virginia.

Disclaimer: These regulations may not be the most recent version. Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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