Ohio Hls 0037 Form Modify Form Here

Ohio Hls 0037 Form

The Ohio HLS 0037 form is a declaration that individuals must complete to disclose any material assistance provided to terrorist organizations as identified by the U.S. Department of State. This form is a critical part of the public employment process in Ohio, ensuring that applicants are not affiliated with entities that support terrorism. It requires truthful responses to specific questions regarding involvement with such organizations.

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The Ohio HLS 0037 form, officially titled the Declaration Regarding Material Assistance/Nonassistance to a Terrorist Organization, plays a critical role in the public employment process within Ohio. This form is mandated by section 2909.34 of the Ohio Revised Code and is designed to ensure that individuals seeking public employment disclose any connections to organizations identified on the U.S. Department of State Terrorist Exclusion List. The questions posed on the form require individuals to answer truthfully regarding their affiliations and activities related to such organizations. A "yes" response to any question, or failing to provide a "no" answer, indicates potential material assistance to a terrorist organization, which carries serious legal implications. This includes a felony charge for knowingly providing assistance or making false statements. The form outlines what constitutes "material support or resources," encompassing a wide range of financial and logistical support, while explicitly excluding medicine and religious materials. Additionally, the form provides a mechanism for individuals to request a review if their public employment application is denied based on a positive indication of assistance to a terrorist organization. Understanding the importance of this form is essential for anyone involved in public employment in Ohio, as compliance is not only a legal requirement but also a matter of public safety and integrity.

Form Sample

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.

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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.

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Form Information

Fact Name Fact Description
Governing Law This form is governed by section 2909.34 of the Ohio Revised Code.
Purpose The form serves as a declaration regarding material assistance or non-assistance to terrorist organizations.
Disclosure Requirement Any "yes" answer indicates that material assistance has been provided to an organization on the U.S. Department of State Terrorist Exclusion List.
Felony Classification Failure to disclose material assistance or making false statements is classified as a felony of the fifth degree.
Definition of Material Support Material support includes currency, financial services, training, and various physical assets, excluding medicine or religious materials.
Review Process A review of denial for public employment can be requested if material assistance is indicated.
Signature Requirement The form must be signed and dated to certify the truthfulness of the provided information.
Contact Information Home and work phone numbers are required for identification purposes.
Response Accuracy Responses must be truthful to the best of the individual's knowledge.
Organization Membership Questions on the form inquire about membership in organizations listed on the U.S. Department of State Terrorist Exclusion List.
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