<div class="widget vfb_widget_class"><h2 class="widgettitle">Afghanistan Refugee Assistance</h2>
 
  • BACKGROUND INFORMATION DISCLOSURE (BID)

  • • PENALTY: Knowingly providing false information or omitting information may result in a forfeiture of up to $1,000 and other sanctions as provided in Wis. Admin. Code § DHS 12.05(4). • Completion of this form is required under the provisions of Wis. Stat. § 50.065. Failure to comply may result in a denial or revocation of your license, certification, or registration, or denial or termination of your employment or contract. • Providing your social security number is voluntary; however, your social security number is one of the unique identifiers used to prevent incorrect matches. • Refer to DQA form F-82064A, BID Instructions, for additional information.
  • A “NO” answer to all questions does not guarantee employment, residency, a contract, or regulatory approval.

  • SECTION B – OTHER REQUIRED INFORMATION

 

Verification

</div>