I affirm and attest that I meet the Moral Character requirements for sponsorship or employment as required by DOORTOID in the country of Republic of Indonesia.

I have not been arrested with disposition pending or found guilty of regardless of adjudication, or entered a plea of no contest to or have been adjudicated delinquent and the record has not been sealed or expunged for, any offense prohibited under any of the following provisions of the country of origin or under any similar statute of another jurisdiction for any of the offenses listed below.

Criminal Offenses Listed

1. Relating to sexual misconduct with certain developmentally disabled clients and reporting of such sexual misconduct.
2. Relating to sexual misconduct with certain mental health patients and reporting of such sexual misconduct.
3. Relating to adult abuse, neglect, or exploitation of aged persons or disabled adults.
4. Relating to attempts, solicitation, and conspiracy to commit an offense listed in this subsection.
5. Relating to murder.
6. Relating to manslaughter, aggravated manslaughter of an elderly person or disabled adult, or aggravated manslaughter of a child.
7. Relating to vehicular homicide.
8. Relating to killing of a quick unborn child by injury to the mother.
9. Relating to assault, battery, and culpable negligence if the offense was a felony.
10. Relating to assault if the victim of the offense was a minor.
11. Relating to battery if the victim of the offense was a minor.
12. Relating to kidnapping.
13. Relating to false imprisonment.
14. Relating to luring or enticing a child.
15. Relating to taking, enticing or removing a child beyond the state limits with criminal intent pending custody proceedings or to avoid producing a child at a custody hearing or delivering the child to the designated person.
16. Relating to exhibiting firearms or weapons or possessing an electric weapon or device, destructive device, or other weapon.
17. Relating to sexual battery
18. Relating to prohibited acts of persons in familial or custodial authority.
19. Relating to unlawful sexual activity with certain minors.
20. Relating to lewd and lascivious behaviour.
21. Relating to lewdness and indecent exposure.
22. Relating to burglary.
23. Relating to voyeurism if the offense is a felony.
24. Relating to video voyeurism if the offense is a felony.
25. Relating to theft, robbery, and related crimes if the offense is a felony.
26. Relating to fraudulent sale of controlled substances, only if the offense was a felony.
27. Relating to abuse, aggravated abuse, or neglect of an elderly person or disabled adult.
28. Relating to contributing to the delinquency or dependency of a child.
29. Relating to exploitation of an elderly person or disabled adult if the offense was a felony.
30. Relating to incest.
31. Relating to child abuse, aggravated child abuse, or neglect of a child.
32. Relating to contributing to the delinquency or dependency of a child.
33. Relating to negligent treatment of children.
34. Relating to sexual performance by a child.
35. Relating to resisting arrest with violence.
36. Relating to depriving a law enforcement, correctional, or correctional probation officer means of protection or communication.
37. Relating to aiding in an escape or in the escape of juvenile inmates.
38. Relating to obscene literature.
39. Relating to encouraging or recruiting another to join a criminal gang.
40. Relating to drug abuse prevention and control, only if the offense was a felony or if any other person involved in the offense was a minor.
41. Relating to sexual misconduct with certain forensic clients and reporting of such sexual misconduct.
42. Relating to inflicting cruel or inhuman treatment on an inmate resulting in great bodily harm.
43. Relating to escape.
44. Relating to harbouring, concealing, or aiding an escaped prisoner.
45. Relating to introduction of contraband into a correctional facility.
46. Relating to sexual misconduct in juvenile justice programs.
47. Relating to contraband introduced into detention facilities.
48. Has not committed an act that constitutes domestic violence whether such act was committed in the country of origin or in another jurisdiction.

The Following Acknowledgements Apply to All Guarantee

• I affirm that I have not been designated as a sexual predator pursuant; a career offender pursuant; or a sexual offender pursuant.
• I understand that I must acknowledge the existence of any applicable criminal record relating to the above lists of offenses including those under any similar statute of another jurisdiction, regardless of whether or not those records have been sealed or expunged. I hereby release, waive, discharge, and hold harmless DOORTOID and all employees past or present or future from any claims, suits, liabilities, judgments, costs and expenses, and compensations arising out of or in any way related to my entry, presence, and exit to, in, and / or from Indonesia.
• I understand that, while sponsored, employed or volunteering in any position that requires DOORTOID background screening as a condition of guaranteed. I must immediately notify DOORTOID of any arrest, any notice of possible criminal prosecution including any violation or infraction mandating a court appearance. Reporting must be done immediately if during normal working hours or immediately the next business day if after normal working hours.

 

I attest that I have read the above carefully and state that my attestation here is true and correct and that my record does not contain any of the above listed offenses. If there are any misinformation from the above that I will not hold DOORTOID accountable. I understand, under penalty of perjury, all employees or sponsored party in such positions of trust or responsibility shall attest to meeting the requirements to the background screening standards.