Ohio Form Hls 0037 PDF Details

Navigating the intricacies of ensuring public safety and legal compliance can often seem like a daunting task, especially when it involves discerning connections to organizations that might compromise that safety. The Ohio HLS 0037 form is a vital tool in this endeavor, developed by the Ohio Department of Public Safety Division of Homeland Security. It's designed primarily to screen public employees for any potential provision of material assistance to terrorist organizations or those that support terrorism, as outlined by the U.S. Department of State Terrorist Exclusion List. This robust document requires declarants to candidly respond to a series of pointed questions, addressing whether they have any affiliations or have provided any form of material support to listed organizations. Failing to provide truthful responses, or omitting information, not only disqualifies one from public employment but is also considered a felony of the fifth degree under Ohio law. Additionally, the form delineates what qualifies as "material support or resources," encompassing everything from financial contributions to the provision of safe houses or transport. In essence, the Ohio HLS 0037 form serves as a formidable barrier against the infiltration of public positions by individuals who may undermine public safety and national security, thereby ensuring that the pillars of trust and safety within public employment remain unshaken.

QuestionAnswer
Form NameOhio Form Hls 0037
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform public employment request ohio department of public safety public employment form

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Ohio Department of Public Safety

Division of Homeland Security

http://www.homelandsecurity.ohio.gov

PUBLIC EMPLOYMENT

In accordance with section 2909.34 of the Ohio Revised Code

DECLARATION REGARDING MATERIAL ASSISTANCE/NONASSISTANCE TO A TERRORIST ORGANIZATION

This form serves as a declaration of the provision of material assistance to a terrorist organization or organization that supports terrorism as identified by the U.S. Department of State Terrorist Exclusion List (see the Ohio Homeland Security Division website for a reference copy of the Terrorist Exclusion List).

Any answer of “yes” to any question, or the failure to answer “no” to any question on this declaration shall serve as a disclosure that material assistance to an organization identified on the U.S. Department of State Terrorist Exclusion List has been provided. Failure to disclose the provision of material assistance to such an organization or knowingly making false statements regarding material assistance to such an organization is a felony of the fifth degree.

For the purposes of this declaration, “material support or resources” means currency, payment instruments, other financial securities, funds, transfer of funds, and financial services that are in excess of one hundred dollars, as well as communications, lodging, training, safe houses, false documentation or identification, communications equipment, facilities, weapons, lethal substances, explosives, personnel, transportation, and other physical assets, except medicine or religious materials.

LAST NAME

 

 

 

FIRST NAME

 

 

 

MIDDLE INITIAL

 

 

 

 

 

 

 

 

 

HOME ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

STATE

 

ZIP

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HOME PHONE

 

 

WORK PHONE

 

 

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DECLARATION

In accordance with division (A)(2)(b) of section 2909.32 of the Ohio Revised Code

For each question, indicate either “yes,” or “no” in the space provided. Responses must be truthful to the best of your knowledge.

1.Are you a member of an organization on the U.S. Department of State Terrorist Exclusion List? Yes No

2.Have you used any position of prominence you have with any country to persuade others to support an organization on the U.S. Department of State Terrorist Exclusion List?

Yes No

3.Have you knowingly solicited funds or other things of value for an organization on the U.S. Department of State Terrorist Exclusion List?

Yes No

HLS 0037 2/06

PUBLIC EMPLOYMENT - CONTINUED

4.Have you solicited any individual for membership in an organization on the U.S. Department of State Terrorist Exclusion List?

Yes No

5.Have you committed an act that you know, or reasonably should have known, affords "material support or resources" to an organization on the U.S. Department of State Terrorist Exclusion List?

Yes No

6.Have you hired or compensated a person you knew to be a member of an organization on the U.S. Department of State Terrorist Exclusion List, or a person you knew to be engaged in planning, assisting, or carrying out an act of terrorism?

Yes No

In the event of a denial of public employment due to a positive indication that material assistance has been provided to a terrorist organization, or an organization that supports terrorism as identified by the U.S. Department of State Terrorist Exclusion List, a review of the denial may be requested. The request must be sent to the Ohio Department of Public Safety’s Division of Homeland Security. The request forms and instructions for filing can be found on the Ohio Homeland Security Division website.

CERTIFICATION

I hereby certify that the answers I have made to all of the questions on this declaration are true to the best of my knowledge. I understand that if this declaration is not completed in its entirety, it will not be processed and I will be automatically disqualified. I understand that I am responsible for the correctness of this declaration. I understand that failure to disclose the provision of material assistance to an organization identified on the U.S. Department of State Terrorist Exclusion List, or knowingly making false statements regarding material assistance to such an organization is a felony of the fifth degree. I understand that any answer of “yes” to any question, or the failure to answer “no” to any question on this declaration shall serve as a disclosure that material assistance to an organization identified on the U.S. Department of State Terrorist Exclusion List has been provided by myself or my organization.

X

Signature

Date

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Ohio Form Hls 0037 writing process described (step 1)

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Stage number 2 of filling out Ohio Form Hls 0037

3. Completing PUBLIC EMPLOYMENT CONTINUED Have, Exclusion List, Yes, Have you committed an act that, to an organization on the US, Yes, Have you hired or compensated a, Yes, and In the event of a denial of public is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Filling in part 3 in Ohio Form Hls 0037

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