Employer Fingerprint Clearance Certification I certify that I, the owner or authorized representative of ___________________________________________ (company), have conducted a criminal background check of all employees who will have contact with JCS-Inc. students, through the Department of Justice (DOJ), in accordance with Education Code §45125.1 and I certify to the JCS-INC. that no employee of _____________________________________________ (company) working with students of JCS-INC. has been convicted of a violent or serious felony as defined by statute, nor has a criminal action pending upon charges of commission of a violent or serious felony as defined by statute. ________________________________________ ______________________________ Owner or Authorized Representative Signature Date ________________________________________ ______________________________ Print Name Title Please list all employees or partners who will come in contact with JCS-Inc. students. You may attach another sheet if necessary. ❑ CDE-NPA Cert exp date ❑ DOJ-ORI Acct # (attach copy) Revised 5/22/2020