(a) The agency shall conduct a comprehensive background check of all employees and prospective employees. The agency shall require the employee or prospective employee to complete and sign a form which contains questions as to whether the current or prospective employee has been convicted of a crime involving violence or dishonesty in a state court or federal court in any state, or was subject to any decision imposing disciplinary action by a licensing agency in any state, the District of Columbia, a United States possession or territory or a foreign jurisdiction. The certification by each employee or prospective employee shall read: "I certify that the statements made by me on this application are true and complete to the best of my knowledge and are made in good faith. I understand that if I knowingly make any misstatements of fact, I am subject to disqualification, dismissal, or other action pursuant to employment agency policy and procedure, and subject to criminal penalties as prescribed by law."