22 Va. Admin. Code § 40-90-30 - 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.
Notes
Statutory Authority
§§ 63.2-1702, 63.2-1720 and 63.2-1721 of the Code of Virginia.
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