"Volunteer Qualification Inquiry Firearm Possession" - Alaska

Volunteer Qualification Inquiry Firearm Possession is a legal document that was released by the Alaska Department of Fish and Game - a government authority operating within Alaska.

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  • Released on January 1, 2016;
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Download "Volunteer Qualification Inquiry Firearm Possession" - Alaska

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STATE OF ALASKA
VOLUNTEER QUALIFICATION INQUIRY
FIREARM POSSESSION
The activities in which you have volunteered to participate require or permit you to possess or use ammunition or a
firearm. Therefore, before you may participate in this Fish and Game project, you are required to complete this
Qualification Inquiry - Firearm Possession form and deliver it to your project supervisor to be attached to your
Volunteer Agreement.
In completing this form, you are advised of the following:
a) You are directed to complete this form. Failure to reply fully and truthfully will result in your restriction
from the project.
b) Neither your answers nor any evidence gained by reason of your answers can be used against you in any
criminal prosecution for a violation of Title 18, United States Code, Section 922(g)(9). However, the
answers you furnish and any information or evidence resulting therefrom may be used against you in a
prosecution for knowingly and willfully providing false statements or information.
1. Have you ever been convicted of a misdemeanor crime of domestic violence within the meaning of 18 U.S.C.,
Sec. 921(a)(33)(A)?
Yes
No
If your answer to this question is “No,” you do not need to provide the information in item 2. You must,
however, sign this form certifying that it is true and that you will report any future conviction of a misdemeanor
crime of domestic violence within the meaning of 18 U.S.C., Sec. 921(a)(33)(A), and deliver it to your project
supervisor.
2. If your answer to question number 1 is “Yes,” provide the following information with respect to the conviction(s),
sign this form, and refrain from any volunteer activities until a determination on your volunteer status is made.
Court/Jurisdiction
Docket/Case Number
Statute
Charge
Date Sentenced
…………………………………………………………………………………………………………………………….
I hereby certify that all the information provided by me is true, correct, complete, and made in good faith. I
understand that false, misleading, or incomplete information provided herein may be grounds for removal from the
project, and is also punishable pursuant to federal law, including 18 U.S.C., Sec. 1001, and under Alaska State law as
unsworn falsification (AS 11.56.210). I agree that I will immediately report any future conviction of a misdemeanor
crime of domestic violence within the meaning of 18 U.S.C., Sec. 921(a)(33)(A) to my project supervisor. I
understand that failure to provide such a report is grounds for removal from the project.
Name (Print or type): _____________________________________________________________________
Signature: ______________________________________________
Date: ________________________
(Or parent of minor volunteer)
Volunteer for ADFG Division of Wildlife Conservation, Statewide Programs, Hunter Information and Training Program
ADF&G Rev 1/16 Volunteer
Page 1 of 1
STATE OF ALASKA
VOLUNTEER QUALIFICATION INQUIRY
FIREARM POSSESSION
The activities in which you have volunteered to participate require or permit you to possess or use ammunition or a
firearm. Therefore, before you may participate in this Fish and Game project, you are required to complete this
Qualification Inquiry - Firearm Possession form and deliver it to your project supervisor to be attached to your
Volunteer Agreement.
In completing this form, you are advised of the following:
a) You are directed to complete this form. Failure to reply fully and truthfully will result in your restriction
from the project.
b) Neither your answers nor any evidence gained by reason of your answers can be used against you in any
criminal prosecution for a violation of Title 18, United States Code, Section 922(g)(9). However, the
answers you furnish and any information or evidence resulting therefrom may be used against you in a
prosecution for knowingly and willfully providing false statements or information.
1. Have you ever been convicted of a misdemeanor crime of domestic violence within the meaning of 18 U.S.C.,
Sec. 921(a)(33)(A)?
Yes
No
If your answer to this question is “No,” you do not need to provide the information in item 2. You must,
however, sign this form certifying that it is true and that you will report any future conviction of a misdemeanor
crime of domestic violence within the meaning of 18 U.S.C., Sec. 921(a)(33)(A), and deliver it to your project
supervisor.
2. If your answer to question number 1 is “Yes,” provide the following information with respect to the conviction(s),
sign this form, and refrain from any volunteer activities until a determination on your volunteer status is made.
Court/Jurisdiction
Docket/Case Number
Statute
Charge
Date Sentenced
…………………………………………………………………………………………………………………………….
I hereby certify that all the information provided by me is true, correct, complete, and made in good faith. I
understand that false, misleading, or incomplete information provided herein may be grounds for removal from the
project, and is also punishable pursuant to federal law, including 18 U.S.C., Sec. 1001, and under Alaska State law as
unsworn falsification (AS 11.56.210). I agree that I will immediately report any future conviction of a misdemeanor
crime of domestic violence within the meaning of 18 U.S.C., Sec. 921(a)(33)(A) to my project supervisor. I
understand that failure to provide such a report is grounds for removal from the project.
Name (Print or type): _____________________________________________________________________
Signature: ______________________________________________
Date: ________________________
(Or parent of minor volunteer)
Volunteer for ADFG Division of Wildlife Conservation, Statewide Programs, Hunter Information and Training Program
ADF&G Rev 1/16 Volunteer
Page 1 of 1