FBI 10 Year Self-Certification Form

This is an FBI affidavit self-certification. If you have been a Pennsylvania resident for the past 10 years/have not committed any felonies, please confirm this and list all eligible addresses that you have lived at in that timeframe.

Your name *

Email address *

I swear/affirm that I am a volunteer at Faith Church and AM NOT required to obtain a clearance through the Federal Bureau of Investigation, as I have been a resident of Pennsylvania during the entirety of the previous ten year period.

I certify I have never been convicted of a felony in any state at any time.

Address

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