10+ Self-Certification Forms – PDF

A self-certification form is a document which is identical to an affidavit form or a legal declaration form however it is often used for proving an illness or an absence addressed to employers and authorities, and not on claiming other legal matters for a proceeding. The form can either be used by an individual, an organization or an entity, or a controlling person. Nonetheless, this form must be accompanied by other proofs of the user to allow the authority or the recipient in determining the validity of his certification.

Self-Certification Form Sample

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License Medical Self-certification Form

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Size: 267 KB

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Self-Certification Form for Controlling Person

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Size: 72 KB

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Varieties of Self-Certification Forms

The varieties of self-certification forms are numerous since this can be used by different companies and organizations as well as institutions. Below are some of the common varieties of self-certification forms:

Car Wash Self-Certification Form – If an individual plan to open his own car wash business, then he will be required to fulfill the requirements set out by the State or the country regarding car wash business ownership and licensing. One of the requirements is a completed car wash self-certification form which is intended to certify and acknowledge the business that the applicant aims to open and operate. The form contains five parts. The first part of the form is allotted for the general information of the applicant which should have his name and the name of his business, his license number, as well as the address of the applicant’s business company or intended location of the car wash business. The second part of the form centers on compliance which is divided into four sections. The first one will determine the applicant’s understanding with regards to the statements, the rules, and the regulations mandated by the State in relation to his proposed car wash business. The types of permits that the applicant have obtained from the State to begin his business will be detailed in the second section. The third section, on the other hand, will have the final judgments and warrants that the applicant has acquired while the last section states the wage and employment obligations or responsibilities of the applicant for his soon-to-be hired employees and staff to run his business.

In the third part of the form, matters relating to employees and employment opportunities in the applicant’s business will be highlighted such as the names of the already hired employees along with their contract and contact information, and even their addresses. The fourth part of the form discloses the applicant’s successors for the business. Lastly, the applicant will have to affix his signature along with a date on the fifth part of the form which consists of a certification statement indicating his authorization, honesty, and his awareness of the persecutions or penalties if he is proved to have false claims in the form.

Car Wash Self-Certification Form

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Size: 243 KB

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Driver Self-Certification Form – Another type of document which is inlined with vehicles and automobiles is known as a driver self-certification form. However, compared to the aforementioned form variety, this document is intended only to be filled out by an individual who is going to be driving a commercial transportation vehicle. Since there are various transportation vehicle varieties, the form is also to be used only for specific applicants whose vehicle type falls into its inclusion. To complete the form, the applicant should state his purpose of using the form either for an initial self-certification procedure or for updating his previously recorded personal information. The type of self-certificate form which will be needed by the applicant will also be stated in the form along with the particulars of the applicant and the specific documents he will enclose with the completed certification form for his application.

Driver Self-Certification Form

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Loan Applicant Self-Certification Form – Most educational loans are catered by non-profit organizations and groups, however, there are also some which are created and sustained by private entities and even individuals who want to lend a hand in a student’s educational goals and dream. But, before anyone can be a beneficiary or a recipient of an educational loan, one must possess and meet the eligibility requirements as well as fulfill the documents needed by an educational institution. This is when a loan applicant self-certification form becomes relevant as this document will gather the intents, details, and will enlist the rules and regulations, and expectations of the institution for their student loan applicants. The form has six sections where three of which are not to be filled out since it only contains statements and reminders for the applicant. The first section to be completed by the applicant is the cost of attendance and estimated financial assistance information section. This is where the applicant will be able to indicate his needed budget for his cost of attendance for the whole enrollment period which will be covered by the student loan, the overall estimated amount that he will be receiving from the loan, and its difference amounts. The basic details of the applicant ranging from his name up to his choice of enrollment period to be covered by the student loan will also be indicated in this section. Finally, the applicant’s signature and date will complete the form to begin the process of the student loan application.

Loan Applicant Self-Certification Form

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Reciprocal Self-Certification Form – Employers and companies, as well as States who offer retirement opportunities for employed individuals, provide and use a reciprocal self-certification form. This type of certification form variety is for employed individuals to apply for a retirement formula specifically created for them depending on their needs and their contribution to the company. The form has four sections which include a section intended to be filled out by the applicant’s employer or the authorized representative of a business company. The member’s information section is the first area to be completed by the applicant with his personal data and membership status. The type of retirement program or system that the applicant is currently enrolled in will be indicated in the second section of the form while the third section states a certification to be signed by the applicant. The last section is where the employer will be filling in the details of the company along with the applicant’s eligibility date.

Reciprocal Self-Certification Form

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Supplier Self-Certificate Form – This document is suitable to be used by companies who are connecting or partnering with other companies to supply their items for inventory or for the office. In the form, the company details of the supplier will be indicated along with the company’s tax identification number, contact information, and business particulars. The business category of the supplier of whether its company is considered a large or small business enterprise would also be included in the form. In the event that the supplier is a large business company, then further details are required to be disclosed such as the business type, the database used, and affiliated websites which can be used for the verification process.

Supplier Self Certification Form

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How to Complete an Employee Self-Certification Form

Employee self-certification forms are the most common types of self-certification form variety. This document is intended to be filled out and submitted by an employee who will be reporting his absence to his employer or the company that he is working in. The steps below will aid any employee to fulfill the needs and objectives of an employee self-certification form:

Step 1: Determine which sections to fill out. Most employee self-certification forms consist of two or more sections which are intended to be filled out by the employee, wherein one of the sections will be completed by him prior to the day of his sick leave while the other one is to be filled out when he returns to work. To properly determine which section will be suitable to be completed, read the instructions stated on the form and go directly to the appropriate section.

Step 2: Disclose employee particulars. The first section of the form is the employee information section which will center on collecting the basic details of the employee who is reporting his sickness. Some of the particulars which will be disclosed in this section include the employee’s full name, the name of the department where he is assigned, the date of the first day when he was reported to be unfit to work, the estimated length of his absence, the reason for his absence, and the actions which he was able to fulfill such as informing his immediate supervisor or manager about his concerns and employment leave of absence. If the employee had already informed his manager or any authorized officer in the company, then the name of the person he informed must be stated in this section as well along with the date and time of when the employee called that person.

Step 3: Fill in the return-to-work section of the form if returning to the company after the leave period. This section is for employees who have already accrued their leave days. In this section, the employee will be required to indicate the dates of when he was first recommended to stay at home for he is unfit to work along with the date of when he returned to work and the date of when his sickness or medical condition was considered healed or cured. The employee will then have to mark the days of the week when he was unable to report and work at the office ranging from the first day of the week which is Sunday up to the last day of the week which is a Saturday. Moreover, the number of hours when the employee was able to work and when he was absent during the week will also be included as well as whether or not his absence was due to a disability or an acquired injury in the workplace.

Step 4: State details about the acquired injury. If the reason of the employee’s leave was due to a workplace accident resulting in an injury, then this section should be filled out as well which should have the description of the incident along with the indication of whether the physician conducted a risk assessment or not and a few comments of the employee as he returns at work to a meeting with his immediate supervisor or manager.

Step 5: Sign the form. After filling out the sections required to be completed based on the employee’s situation, the employee must affix his signature on the form and state the date of when he used the form. The signature and the date will serve as an indication that the employee is certifying his statements and disclosed details on the sections of the form as factual and accurate.

Self-Certification Absence Form

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What Documents Can Accompany a Self-Certification Form?

There are some documents which are needed to be submitted along with a self-certification form and these are enlisted below:

  • Medical statement forms – This type of accompanying document is essential to be provided by the filer’s physician. The purpose of having a medical statement form is to ensure that the filer or the user of the form have undergone sufficient medical procedures to cure his illness and address his health concerns. For instance, if the self-certification form is intended to be filled out and filed by company employees, then the medical statement will prove the claims of employees for their capability to continue working and accomplishing their tasks.
  • Risk assessment result – Side to side with the aforementioned medical statement form, this document serves as a guide for an organization or a company to determine what adjustments must be executed in order to meet the medical needs of the person submitting the self-certification form. The risk assessment form can also be used for determining what other roles and responsibilities the user of the self-certification form can execute successfully with less supervision, specifically if he is an employee of the company.

Self-Certification Medical Form

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Size: 85 KB

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Student Self-Certification Form

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Size: 68 KB

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Tax Residency Self-Certification Form

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Size: 1 MB

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Regardless of the documents which will be required by companies and organizations or the recipients of the completed self-certification forms, the data and the disclosed details in each document must be kept confidential and up to date whenever there will be changes to be observed and mandated in relation to the collected information.

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