To be signed by applicants who have accepted a conditional offer of employment and will begin work on a
provisional basis after preliminary background check is , and pending the outcome of State or Federal
fingerprint background results. A copy of this signed attestation must be kept in the conditional hire’s personnel

Name of Provisional Hire (print name):  

Has accepted Provisional Employment with (location name):  

Disclosures (if none state “none”):  

This person is personally known to me or produced the following identification, Drivers License, on this October 2, 2023

Witness (type or print name): Charles Williams           Title: Administrator

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Signature Certificate
Document name: Good Moral Attestation
lock iconUnique Document ID: 3955bf4c73b8a37c2a2a217578e262d940ae4cb2
Timestamp Audit
February 16, 2023 10:33 am EDTGood Moral Attestation Uploaded by Assist Medical Staffing - IP
February 16, 2023 10:35 am EDT Document owner has handed over this document to 2023-02-16 10:35:38 -