Murder Conviction Certification Form
According to the final National Service Criminal History Final Rule issued on October 5, 2012, individuals who have been convicted of murder are ineligible to serve in national service programs.
To be eligible to serve in AmeriCorps or another national service program, all members and staff who are currently serving or working under a national service grant and who started service/work prior to the October 2009 regulations must self-certify that they have never been convicted of murder.
If a covered individual refuses to certify this, or if the individual has ever been convicted of murder, they must be removed from serving or working with national service by January 1, 2013.
Please initial one of the following statements:
Declaration of No Murder Conviction
I certify that I have never been convicted of murder.
Declaration of Murder Conviction
I certify that I have been convicted of murder. I understand that this makes me ineligible to serve or work with a
national service program.
I certify under penalty of perjury, that the above information is true, correct, and complete.
Signature Date
Name
Please note: The definition of murder in 18 U.S.C. 1111 is as follows: ‘‘Murder is the unlawful killing of a human being with malice aforethought. Every murder perpetrated by poison, lying in wait, or any other kind of willful, deliberate, malicious, and premeditated killing; or committed in the perpetration of, or attempt to perpetrate, any arson, escape, murder, kidnapping, treason, espionage, sabotage, aggravated sexual abuse or sexual abuse, child abuse, burglary, or robbery; or perpetrated as part of a pattern or practice of assault or torture against a child or children; or perpetrated from a premeditated design unlawfully and maliciously to effect the death of any human being other than him who is killed, is murder in the first degree. Any other murder is murder in the second degree.’’