Henry County School System

Henry County School System

217 Grove Boulevard Paris, Tennessee 38242

731-642-9733 Fax: 731-641-4493 Tiffany Latta, Director of Human Resources lattat@

Waiver Agreement and Statement for Criminal History Checks

This form must be completed and signed by every current or prospective employee, volunteer and contractor/vendor, for whom criminal history records are requested by a qualified entity.

RETURN THIS COMPLETED FORM TO THE HENRY COUNTY SCHOOL SYSTEM - HUMAN RESOURCES DEPARTMENT

I hereby authorize Henry County School System to submit a set of fingerprints through the TBI vendor and this form to the Tennessee Bureau of Investigation (TBI), for the purpose of accessing and reviewing Tennessee and national criminal history that may pertain to me directly from the FBI, pursuant to 28 CFR, Sections 16.30-16.34. By signing this Waiver Agreement, it is my intent to authorize the dissemination of any national criminal history record that may pertain to me to the Qualified Entity with which I am or am seeking to be employed or to serve as a volunteer.

I understand that, until the criminal history background check is completed, you may choose to deny me unsupervised access to entity locations. I further understand that, upon request, you will provide me with a copy of the criminal history background report, if any, you receive on me and that I am entitled to challenge the accuracy and completeness of any information contained in any such report. I may obtain a prompt determination as to the validity of my 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: Henry County Schools Address: 217 Grove Blvd. City: Paris State: TN Zip: 38242

I have OR have not been convicted of a crime.

If convicted, describe the crime(s) and the particulars of the convictions(s) in the space below:

I am a current (check one):

Employee Volunteer Contractor/Vendor

Signature: ____________________________________________ Date:

Printed Name:

Address:

City:

State:

Zip:

Date of Birth ? REQUIRED:

THIS FORM MUST BE RETURNED TO THE HENRY COUNTY SCHOOL SYSTEM'S HUMAN RESOURCES DEPARTMENT (ADDRESS/FAX OR EMAIL ABOVE) BEFORE BACKGROUND CHECK WILL BE APPROVED

RDA

Henry County School System

217 Grove Boulevard Paris, Tennessee 38242

731-642-9733 Fax: 731-642-8073

Noncriminal Justice Applicant's Privacy Rights

As an applicant, student teacher, practicum student or volunteer who is the subject of a national fingerprint-based criminal history record check for a noncriminal justice purpose (such as an application for employment or a license, an immigration or naturalization matter, security clearance, or adoption), you have certain rights which are discussed below.

You must be provided written notification1that your fingerprints will be used to check the criminal history records of the FBI.

You must be provided, and acknowledge receipt of, an adequate Privacy Act Statement when you submit your fingerprints and associated personal information. This Privacy Act Statement should explain the authority for collecting your information and how your information will be used, retained, and shared.2

If you have a criminal history record, the officials making a determination of your suitability for the employment, license, or other benefit must provide you the opportunity to complete or challenge the accuracy of the information in the record.

The officials must advise you that the procedures for obtaining a change, correction, or update of your criminal history record are set forth at Title 28, Code of Federal Regulations (CFR), Section 16.34.

If you have a criminal history record, you should be afforded a reasonable amount of time to correct or complete the record (or decline to do so) before the officials deny you the employment, license, or other benefit based on information in the criminal history record.3

You have the right to expect that officials receiving the results of the criminal history record check will use it only for authorized purposes and will not retain or disseminate it in violation of federal statute, regulation or executive order, or rule, procedure or standard established by the National Crime Prevention and Privacy Compact Council.4

If agency policy permits, the officials may provide you with a copy of your FBI criminal history record for review and possible challenge. If agency policy does not permit it to provide you a copy of the record, you may obtain a copy of the record by submitting fingerprints and a fee to the FBI. Information regarding this process may be obtained at

If you decide to challenge the accuracy or completeness of your FBI criminal history record, you should send your challenge to the agency that contributed the questioned information to the FBI. Alternatively, you may send your challenge directly to the FBI. The FBI will then forward your challenge to the agency that contributed the questioned information and request the agency to verify or correct the challenged entry. Upon receipt of an official communication from that agency, the FBI will make any necessary changes/corrections to your record in accordance with the information supplied by that agency.

__________________________________________________

1 Written notification includes electronic notification, but excludes oral notification. 2 3See 28 CFR 50.12(b). 4See 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) and 906.2(d).

Fingerprinting Instructions-Henry County Board of Education

All employees, substitute applicants and volunteers for the Henry County Board of Education MUST be fingerprinted. These directions are subject to change based on website changes by company

For questions, please contact HCBOE at 731-642-9733 Monday through Friday 8:00 a.m. until 4:00 p.m.

1. You MUST pre-register online at locations/tennessee

2. If you do not have access to the internet, you may call them toll-free at 1-855-226-2937 to schedule an appointment. If

you call, you will be asked the following questions instead of completing these steps yourself.

3. Click Digital Fingerprinting

4. Click Schedule a New Appointment

5. Agency Name: State Schools/Colleges and click "go"

6. Choose the proper Applicant Type and click "go"

If you are registering by phone you will need to choose from one of the following:

BD

Bus Driver

CA

Cafeteria/Food Service Workers

CW

Custodial Workers

ST

Substitute Teachers

SW

Other Employees (Teacher Assistants)

SWV

Volunteers

TE

Teachers

7. Enter Henry County School System's ORI number: TN930680Z and click "go"

8. Confirm Henry Co Board of Education, click "yes"

9. Agree to acknowledgement/release and click "go"

10. Enter Zipcode and click "go"

11. Click on the words "Click to Schedule" across from the location you want, under the day you wish to be fingerprinted. If you

want a date further in the future, click the "Next Week" link to display more dates. Once you select the location/date

combination, select the time for your appointment and click "go".

LOCATIONS ARE SUBJECT TO CHANGE

CLOSEST AVAILABLE LOCATIONS

Westan

Center Point Business Workcare Resources Express Personnel The UPS Store

Insurance Group Solutions

Inc.

Services

64 Commerce St. 1413 S. Home St.

16 Murray Guard Dr. 432 Hwy 46 S

2277 Wilma Rudolph Blvd.

Paris, TN 38242 Hours:

Union City, TN 38261 Jackson, TN 38305

Hours:

Hours:

Dickson, TN 37055 Clarksville, TN 37040

Hours:

Hours:

M-F 8:30-4:20

M-F 8:30-4:15

M-F 8:30-4:10

M-F 9-4

M-F 9-5 Sat. 9-2

12. Complete the Applicant Information. Required fields are indicated by a red asterisk (*). When complete, click "Send Information"

13. Confirm the information. Follow the on-screen directions to make any changes necessary. Once you see the data is correct, click "Send Information".

14. You will then be presented with payment options. Fingerprinting fee is $35.15 which can be paid online with a

credit card/debit card or in advance by calling the phone number listed above. You may also pay at the time of fingerprinting No cash or personal checks will be accepted. If paying online complete your payment process and click "Send Payment Information" 15. Print your confirmation page. 16. At the time of fingerprinting you must have valid identification, such as driver's licenses, social security card, birth certificate or valid picture identification. 17. Arrive at the location selected at your appointed date and time. 18. The Enrollment Officer at the site will check your ID, verify your information, verify or collect payment, capture your fingerprints and submit your data. This normally takes less than five minutes. REIMBURSEMENT PROCEDURES Individuals hired as full-time employees will be reimbursed by a paper check mailed to the employee's home address at the first available opportunity from the Finance Office. Substitute employees will be reimbursed after completing ten days of employment. Practicum students, student teachers and volunteers are to complete the background check at their own cost and will not be reimbursed by the district (it is not necessary for these individuals to return a copy of the receipt). Individuals that qualify to be reimbursed for the background check (see above), will need to return the receipt (which will be provided at the end of the background check appointment). Return receipt to the receptionist at the HCBOE Central Office (217 Grove Blvd. Paris, TN). HCBOE cannot process reimbursement without a copy of receipt & signed waiver on page 1 of these directions. All results will be processed and delivered to Henry County School System for processing by TBI. Identogo/Morpho Trust is

never in possession of criminal record data results.

Last updated 2/6/19

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