Criminal History/Background Check

Texas Education Code 22.083 authorizes a school district to obtain the criminal history record of every applicant for employment in this school district.

Name*

First Last

Email*

Gender*

Social Security Number*

Date of Birth*

Place of Birth*

City, County, State

Phone*

Ethnicity

Driver's License #*

Issuing State

Expiration Date

Have you ever used another name(s) including maiden name?*

Yes
No

What was your previous name?*

Have you ever lived in another state (other than Texas) or country in the past 10 years?*

Yes
No

Reason for Background Check*

Volunteer
Watch Dog
RAP Mentor

Campus*

Compliance*

In compliance with state law, Bellville Independent School District shall obtain the criminal history record information for each applicant for employment, who in the opinion of the district, is a serious candidate and may be offered a position. If hired, this information shall be obtained at periodic intervals through continual employment with Bellville ISD.

I hereby authorize any law enforcement agency, including a police department, the Texas Department of Public Safety and the Texas Department of Corrections, to release to this school district my complete criminal history record. I understand that the District is prohibited by Federal Regulations from providing me with a copy of my DPS criminal history report, however, I further understand that upon my request, the District may quote to me data from the report. Thereafter, I have the right to challenge the accuracy of my DPS criminal history record.

I understand the information I am providing about age, sex, and race/ethnicity will not be used to determine eligibility for employment, but will be used solely for the purpose of obtaining criminal history record.

DPS Computerized Criminal History (CCH) Verification

I, applicant or employee named above, acknowledge that a Computerized Criminal History (CCH) check will be performed by accessing the Texas Department of Public Safety Secure Website and will be based on name and DOB identifiers I supply. (This is not a consent form.) Authority for this agency to access an individual's criminal history data may be found in Texas Government Code 411; Subchapter F.

Name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history, therefore the organization conducting the criminal history check is not allowed to discuss with me any criminal history record information obtained using this method. The agency may request that I have a fingerprint search performed to clear any misidentification based on the result of the name and DOB, search. Once this process is completed the information on my fingerprint criminal history record may be discussed with me.

In order to complete the process I must make an appointment with the Fingerprint Applicant Services of Texas (FAST) as instructed online at www.txdps.state.tx.us /Crime Records/Review of Personal Criminal History or by calling the DPS Program Vendor at 1-888-467-2080, submit a full and complete set of fingerprints, request a copy be sent to the agency listed below, and pay a fee of $24.95 to the fingerprinting services company.

Acknowledgment*

I have read and understand the information above.

Signature

Signature of Applicant*