CRIMINAL RECORD CHECK FORM - New Hampshire School ...



CRIMINAL RECORD CHECK FORM

Name: _______________________________________________________________

Address: _____________________________________________________________

City/Town: ____________________________________Zip Code: ______________

Date of Birth: ________________ Social Security #: _______________________

Telephone: Home ______________________ Work ________________________

1. Notarized NHSP Criminal Record Release Authorization Form and a complete set of fingerprints on FBI Applicant Fingerprint Card (blue ink, white background Form # FD258) arrived at the SAU Office or School Bus Company.

Date: __________________ Initialed _____________________

Make sure that the FBI Applicant Fingerprint Card is complete and filled in with all the proper information.

2. NHSP Criminal History Record Release Authorization Form and FBI Applicant

Fingerprint Card sent to the NH State Police, Criminal Records Division

Date: _____________________ Initialed: __________________

3. NHSP Criminal Record Division Advisory letter arrived at SAU Office or School Bus Company.

Date: _____________________ Initialed: ___________________

4. FBI Record Check Letter arrived at the SAU Office or School Bus Company.

Date: ______________________ Initialed: ____________________

5. NHSP Criminal History Record Release Authorization Form and Advisory Letter

DESTROYED.

Date: ______________________ Initialed: _____________________

(The Criminal Record Release Authorization Form must be immediately destroyed if no

record is indicated and within 30 days if applicant has a criminal record)

Revised 6/7/10

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