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Tennessee State UniversityCriminal Background Check RequestProcedures1. Register with IdentoGo Pre-register online at http://www.identogo.com.Follow below Instructions:2. Complete & Submit original of the following items: VECHS Waiver Agreement, Privacy Act forms,and Criminal Background Check Request Form (located online www.tnstate.edu/teachered or Clay 112.3.4.5.6.7.8.Select Get Fingerprinted (top right blue)Select State TennesseeSelect Digital FingerprintSelect Schedule a New AppointmentService Code (select Don’t know your service code)Select Agency Non-DCS Child Care/AdoptionProviders9. Applicant Type Child-Related Worker (Private)10. Enter ORI Number: TNCC1913811. Select “Yes” TSU-TESS12. Check I “Agree” Fingerprint-Based Criminal History Record Request Authorization and Notification Form thenpress GO13. Enter in Zip Code and press GO14. Select the location and schedule your time forappointment15. Complete personal information16. Follow other detailed information and make paymentinstructions.NOTE: Access to public and/or private schools/venue (before, during, or after hours) as part of activitywill not be granted until documentation of a clear criminal background check is on file in the TeacherEducation & Student Services Office Clay Room 112.Note IncidentsSubsequent to my completed background check and going forward, it is my responsibility to report any arrest orcriminal citation to the Teacher Education & Student Services Department 615-963-5459 within 48 hours of theincident. Failure to do so may result in dismissal from activity/event. I understand that my clearance iscontingent upon satisfactory results of the fingerprinting and background checks. Background checks are validfor the duration of completing a program. If there is a break in service you must go through the processagain.File: Background Check Clearance Instruction and Location Effective Mar 2019Revised: Sept 30, 2019
BACKGROUND CHECK LOCATIONShttp://www.identogo.com.Cost is 35.15Paid at selected locationImportant Notice regarding ePay OptionsPlease be advised that effective April 15, 2019, we will no longer be accepting credit cardpayments online when scheduling appointments. All credit card payments must be madeonsite at the time of the fingerprinting session.Mt. Juliet, TN-Lebanon Rd IdentoGO11205 Lebanon Rd Mt. Juliet, TN 37122Gallatin, TN-Nashville Pike IdentoGO695 Nashville Pike Gallatin, TN 37066Dickson, TN-Hwy 46 S IdentoGO432 Hwy 46 S Dickson, TN 37055Murfreesboro, TN-N Thompson Ln IdentoGO531 N Thompson Lane Murfreesboro, TN 37129Lebanon, TN-N Castle Heights Ave IdentoGO1020 N Castle Heights Ave Ste A, Lebanon, TN 37087Clarksville, TN-Gracey Ave IdentoGO621 Gracey Ave Clarksville, TN 37040File: Background Check Clearance Instruction and Location Effective Mar 2019Revised: Sept 30, 2019
VECHS WAIVER AGREEMENT AND STATEMENTVolunteer & Employee Criminal History Systemfor Criminal History Record Checksunder the National Child Protection Act of 1993, as amendedPursuant to the National Child Protection Act of 1993, as amended, this form must be completedand signed by every current or prospective employee, volunteer and contractor/vendor, for whomcriminal history records are requested by a qualified entity under these laws.I hereby authorize (enter Name of Qualified Entity) TNCC19138 TSU TESSto submit a set of fingerprints through the TBI vendor and this form to the Tennessee Bureau ofInvestigation (TBI), for the purpose of accessing and reviewing Tennessee and national criminalhistory that may pertain to me directly from the FBI, pursuant to 28 CFR, Sections 16.30-16.34. By signingthis Waiver Agreement, it is my intent to authorize the dissemination of any national criminal historyrecord that may pertain to me to the Qualified Entity with which I am or am seeking to be employed or toserve as a volunteer, pursuant to the National Child Protection Act of 1993, as amended.I understand that, until the criminal history background check is completed, you may choose todeny me unsupervised access to children, the elderly, or individuals with disabilities. I furtherunderstand that, upon request, you will provide me with a copy of the criminal history backgroundreport, if any, you receive on me and that I am entitled to challenge the accuracy and completeness ofany information contained in any such report. I may obtain a prompt determination as to the validity ofmy challenge before you make a final decision about my status as an employee, volunteer, contractor,or subcontractor.A national criminal history background check on me is being requested by: TNCC19138 TSU TESSName of Previous Qualified Entity:Year of Request:Address:Zip:State:City:Ihave ORhave not been convicted of a crime.If convicted, describe the crime(s) and the particulars of the conviction(s) in the space below:BI-xxxxRDA
I am a current or prospective (check one):EmployeeVolunteer Contractor/VendorSignature:Date:Printed Name:Address:City: State:Zip:Date of Birth:TO BE COMPLETED BY QUALIFIED ENTITY:Entity Name:Address:City:Telephone:State:Zip:Fax Number:TBI Transaction Number:ORIGINAL MUST BE RETAINED BY QUALIFIED ENTITYCOPY MUST BE SUBMITTED TO TBI
AGENCY PRIVACY REQUIREMENTS FOR NONCRIMINAL JUSTICE APPLICANTSAuthorized governmental and non-governmental agencies/officials that conduct a national fingerprintbased criminal history record check on an applicant for a noncriminal justice purpose (such asemployment or a license, immigration or naturalization matter, security clearance, or adoption) areobligated to ensure the applicant is provided certain notice and other information and that the results ofthe check are handled In a manner that protects the applicant's privacy. These obligations are pursuantto the Privacy Act of 1974, Title 5, United States Code (U.S.C.) Section 552a, and Title 28, Code of FederalRegulations (CFR), Section 50.12, among other authorities. Officials must provide to the applicant written notificationl 1 that his/her fingerprints will beused to check the criminal history records of the FBI.Officials must ensure that an applicant receives, and acknowledges receipt of, an adequatePrivacy Act Statement when the applicant submits his/her fingerprints and associated personalinformation. 2Officials using the FBI criminal history record (if one exists) to make a determination of theapplicant's suitability for the employment, license, or other benefit must provide the applicantthe opportunity to complete or challenge the accuracy of the information in the record.Officials must advise the applicant that procedures for obtaining a change, correction, or updateof an FBI criminal history record are set forth at 28 CFR 16.34.Officials should not deny the employment, license, or other benefit based on information in thecriminal history record until the applicant has been afforded a reasonable time to correct orcomplete the record or has declined to do so.Officials must use the criminal history record solely for the purpose requested and cannotdisseminate the record outside the receiving department, related agency, or other authorizedentity. 3The FBI has no objection to officials providing a copy of the applicant's FBI criminal history record to theapplicant for review and possible challenge when the record was obtained based on positive fingerprintidentification. If agency policy permits, this courtesy will save the applicant the time and additional FBIfee to obtain his/her record directly from the FBI by following the procedures found at 28 CFR 16.30through 16.34. It will also allow the officials to make a more timely determination of the applicant'ssuitability.Each agency should establish and document the process/procedures it utilizes for how/when it gives theapplicant notice, what constitutes "a reasonable time" for the applicant to correct or complete therecord, and any applicant appeal process that is afforded the applicant. Such documentation will assistState and/or FBI auditors during periodic compliance reviews on use of criminal history records forconcriminal justice purposes.Sign & Date Here that you have read and understand the Privacy ACTWritten notification includes electronic notification, but excludes oral notification.See https://www.fbi.gov/ services/cjis/comp act-council/privacy-act-statement3See 5 U.S.C. 552a(b); 28 U.S.C. 534(b); 42 U.S.C. 14616, Article IV(c); 28 CFR 20.21(c), 20.33(d), S0.12(b) and906.2(d).12
File: Background Check Clearance Instruction and Location Effective Mar 2019 Revised: Sept 30, 2019 Tennessee State University Criminal Background Check Request . Check I "Agree"Fingerprint-Based Criminal History Record Request Authorization and Notification Form then press GO 13. Enter in Zip Code and press GO
