Form W-1 Application for Waiver of Minimum Qualifications - Virginia

Form W-1 or the "Application For Waiver Of Minimum Qualifications" is a form issued by the Virginia Department of Criminal Justice Services.

The form was last revised in June 1, 2015 and is available for digital filing. Download an up-to-date Form W-1 in PDF-format down below or look it up on the Virginia Department of Criminal Justice Services Forms website.

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Commonwealth of Virginia
Virginia Department of Criminal Justice Services
Application for Waiver of Minimum Qualifications (Form W-1)
Section 15.2-1705 Code of Virginia (1950), as amended
Return to: Department of Criminal Justice Service, 1100 Bank Street, 12
Floor, Richmond, VA 23219
th
Applicant’s Name: (Last, First, Middle Initial)
Social Security Number:
Date of Birth:
Agency Requesting Waiver:
Date of Pending Employment:
Waiver Requested for the Following:
Section 15.2-1705, Code of Virginia, (1950) as amended, provides that the Department of Criminal Justice Services may waive the
requirements for minimum employment qualifications for good cause shown. Applications cannot be considered unless adequate
written justification of good cause is provided. Please attach a letter of explanation of good cause for waiver of the minimum
employment qualification as indicated below.
Citizen of the United States
High School Diploma/Equivalency
Not Convicted of a Felony or Any
Offense That Would Be a Felony If
Physical Examination
Valid Driver’s License
Convicted in Virginia
Background Investigation
Be At Least 18 Years of Age
Not Convicted of a Misdemeanor
Offense involving moral turpitude; sex
offense or domestic assault
Not Have Produced a Positive Result on
a Pre-employment Drug Screening
Attest:
I certify that the information provided in this application is true and correct to the best of my knowledge, and I hereby request a waiver
of the minimum qualifications as noted above.
Date
Signature of Applicant
Name of Applicant
Date
Signature of Agency Administrator
For DCJS Use Only:
Request Approved
Request Denied
Reasons/Conditions:
Date
DCJS Authorized Signature
Title
Virginia Department of Criminal Justice Services
June 2015
www.dcjs.virginia.gov
Commonwealth of Virginia
Virginia Department of Criminal Justice Services
Application for Waiver of Minimum Qualifications (Form W-1)
Section 15.2-1705 Code of Virginia (1950), as amended
Return to: Department of Criminal Justice Service, 1100 Bank Street, 12
Floor, Richmond, VA 23219
th
Applicant’s Name: (Last, First, Middle Initial)
Social Security Number:
Date of Birth:
Agency Requesting Waiver:
Date of Pending Employment:
Waiver Requested for the Following:
Section 15.2-1705, Code of Virginia, (1950) as amended, provides that the Department of Criminal Justice Services may waive the
requirements for minimum employment qualifications for good cause shown. Applications cannot be considered unless adequate
written justification of good cause is provided. Please attach a letter of explanation of good cause for waiver of the minimum
employment qualification as indicated below.
Citizen of the United States
High School Diploma/Equivalency
Not Convicted of a Felony or Any
Offense That Would Be a Felony If
Physical Examination
Valid Driver’s License
Convicted in Virginia
Background Investigation
Be At Least 18 Years of Age
Not Convicted of a Misdemeanor
Offense involving moral turpitude; sex
offense or domestic assault
Not Have Produced a Positive Result on
a Pre-employment Drug Screening
Attest:
I certify that the information provided in this application is true and correct to the best of my knowledge, and I hereby request a waiver
of the minimum qualifications as noted above.
Date
Signature of Applicant
Name of Applicant
Date
Signature of Agency Administrator
For DCJS Use Only:
Request Approved
Request Denied
Reasons/Conditions:
Date
DCJS Authorized Signature
Title
Virginia Department of Criminal Justice Services
June 2015
www.dcjs.virginia.gov

Download Form W-1 Application for Waiver of Minimum Qualifications - Virginia

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