HUMAN RESOURCES DEPARTMENT 13801 E Benson Highway • Vail, AZ 85641 • 520-879-2002 • FAX 520-879-2076

AFFIDAVIT & LOYALTY FORMS

The following forms must be notarized. Please print but do not sign these forms. You can take the forms to a Notary Public, or bring them to the Vail School District Office where we offer the service as a courtesy to our employees.

VAIL UNIFIED SCHOOL DISTRICT NO. 20

AFFIDAVIT Please read carefully before signing

Name (Please Print) Position

Signature Date

I, , being duly sworn, do hereby certify that I have never been convicted of or admitted in open court or pursuant to a plea agreement committing, and am not now awaiting trial for committing, any of the following criminal offenses in the state of or similar offenses in any other jurisdiction:

Sexual abuse of a minor Misdemeanor offenses involving the possession or use of marijuana or dangerous drugs Incest Burglary in the first degree First or second degree murder Burglary in the second or third degree Kidnapping Aggravated or armed robbery Arson Robbery Sexual assault A dangerous crime against children as defined Sexual exploitation of a minor in A.R.S. 13-604.01 Felony offenses involving contributing to Child abuse the delinquency of a minor Sexual conduct with a minor Commercial sexual exploitation of a minor Molestation of a child Felony offenses involving sale, distribution, or transportation of, offer to sell, transport, or Manslaughter distribute, or conspiracy to sell, transport, or Aggravated assault distribute marijuana or dangerous or narcotic drugs Assault Felony offenses involving the possession or use Exploitation of minors involving drug offenses of marijuana, dangerous drugs, or narcotic drugs

Subscribed, sworn to, and acknowledged before me by: (print name of applicant)

, this day of , 20 ,

County of

State of

My Commission Expires:

Notary Stamp Notary Signature

LOYALTY

STATE OF ARIZONA ) ) ss COUNTY OF PIMA )

I, , do solemnly swear (or affirm) that I will support the Constitution of the and the Constitution and Laws of the State of Arizona; that I will bear true faith and allegiance to the same, and defend them against all enemies, foreign or domestic, and that I will faithfully and impartially discharge the duties of the office of at (Name of Office)

VAIL UNIFIED SCHOOL DISTRICT # 20 (School District Name and Number) according to the best of my ability, So Help Me God (or so I do affirm.)

(Signature of Officer or Employee)

Acknowledgement by Notary Public:

Subscribed and sworn to before me this day of , A.D. 20 .

Notary Public

My commission expires:

!NOTE: As prescribed, A.R.S. 38-231 and 15-231, every employee in the public schools must subscribe to the oath and file a copy of the oath with the school district of employment at the time and place designated by said school district prior to employment. The District is required to keep the oath on file as long as the employee remains employed by the District: not additional copies of such oath will be required to be filed as long as the employee maintains such continuous employment.