Criminal History/Background Check

Note: This form only needs to be completed once per school year. Please complete the following:

Name*

First Last

Email*

Gender*

Social Security Number*

Date of Birth*

Phone*

Driver's License #*

Issuing State

Expiration Date

What was your previous name?*

Reason for Background Check*

Campus*

Compliance*

Sec. 22.0835. ACCESS TO CRIMINAL HISTORY RECORDS OF STUDENT TEACHERS AND VOLUNTEERS BY LOCAL AND REGIONAL EDUCATION AUTHORITIES. (a) A school district, open-enrollment charter school, or shared services arrangement shall obtain from the department and may obtain from any other law enforcement or criminal justice agency or a private entity that is a consumer reporting agency governed by the Fair Credit Reporting Act (15 U.S.C. Section 1681 et seq.), all criminal history record information that relates to: A school district, open-enrollment charter school, or shared services arrangement may obtain from any law enforcement or criminal justice agency all criminal history record information that relates to a person to whom Subsection (e) applies.

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 record, 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. The information provided 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 acknowledge that a Computerized Criminal History (CCH) check may be performed by accessing the Texas Department of Public Safety Secure Website and may be based on name and DOB identifiers. Authority for this agency to access an individual’s criminal history data may be found in Texas Government Code 411, Subchapter F https://statutes.capitol.texas.gov/ .

Name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history record information (CHRI), therefore the organization conducting the criminal history check is not allowed to discuss with me any CHRI obtained using the name and DOB method.

Optional Only: If the agency directly requests that I also have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search, I can make an appointment with the Fingerprint Applicant Services of Texas (FAST) by visiting the Crime Records General Information | DPS (texas.gov) Review of Personal Criminal History or call 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 $25.00 to the fingerprinting services company. Once this process is completed the information on my fingerprint criminal history record may be discussed with me.

Acknowledgment*

I have read and understand the information above.

Signature

Signature of Applicant*