22VAC40-90-30. Sworn statement or affirmation.

Part II. The Sworn Statement or Affirmation

A. The applicant for licensure shall complete a sworn statement or affirmation upon application for licensure as an assisted living facility.

B. The sworn statement or affirmation shall be completed for all applicants for employment. (NOTE: A model form is available from the department upon request and on the department's website.)

C. Any person making a materially false statement on the sworn statement or affirmation shall be guilty of a Class 1 misdemeanor.

D. The sworn statement or affirmation shall be attached and filed with the criminal history record report.

E. The commissioner shall provide a copy of the sworn statement or affirmation to any applicant denied licensure as an assisted living facility because of information on the sworn statement or affirmation.

F. Further dissemination of the sworn statement or affirmation information is prohibited other than to the commissioner's representative or a federal or state authority or court as may be required to comply with an express requirement of law for such further dissemination.

Statutory Authority

§§ 63.2-1702, 63.2-1720 and 63.2-1721 of the Code of Virginia.

Historical Notes

Derived from VR615-37-01 § 2.1, eff. July 1, 1989; amended, Virginia Register Volume 8, Issue 17, eff. July 1, 1993; Volume 21, Issue 18, eff. July 1, 2005; Volume 22, Issue 22, eff. September 1, 2006.

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