File: Background Check Clearance Instruction and Location Effective Mar 2019 Revised: Sept 30, 2019

Tennessee State University

Criminal Background Check Request Procedures

1. 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. Select Get Fingerprinted (top right blue)

4. Select State Tennessee

5. Select Digital Fingerprint

6. Select Schedule a New Appointment

7. Service Code (select Don’t know your service code)

8. Select Agency Non-DCS Child Care/Adoption

Providers

9. Applicant Type Child-Related Worker (Private)

10. Enter ORI Number: TNCC19138

11. Select “Yes” TSU-TESS

12. Check I “Agree” Fingerprint-Based Criminal History Record Request Authorization and Notification Form then

press GO

13. Enter in Zip Code and press GO

14. Select the location and schedule your time for

appointment

15. Complete personal information

16. Follow other detailed information and make payment

instructions.

NOTE: Access to public and/or private schools/venue (before, during, or after hours) as part of activity

will not be granted until documentation of a clear criminal background check is on file in the Teacher

Education & Student Services Office Clay Room 112.

Note Incidents

Subsequent to my completed background check and going forward, it is my responsibility to report any arrest or

criminal citation to the Teacher Education & Student Services Department 615-963-5459 within 48 hours of the

incident. Failure to do so may result in dismissal from activity/event. I understand that my clearance is

contingent upon satisfactory results of the fingerprinting and background checks. Background checks are valid

for the duration of completing a program. If there is a break in service you must go through the process

again.

File: Background Check Clearance Instruction and Location Effective Mar 2019 Revised: Sept 30, 2019

BACKGROUND CHECK LOCATIONS

http://www.identogo.com.

Cost is $35.15

Paid at selected location Important Notice regarding ePay Options

Please be advised that effective April 15, 2019, we will no longer be accepting credit card payments online when scheduling appointments. All credit card payments must be made onsite at the time of the fingerprinting session.

Mt. Juliet, TN-Lebanon Rd IdentoGO 11205 Lebanon Rd Mt. Juliet, TN 37122

Gallatin, TN-Nashville Pike IdentoGO 695 Nashville Pike Gallatin, TN 37066

Dickson, TN-Hwy 46 S IdentoGO 432 Hwy 46 S Dickson, TN 37055

Murfreesboro, TN-N Thompson Ln IdentoGO 531 N Thompson Lane Murfreesboro, TN 37129

Lebanon, TN-N Castle Heights Ave IdentoGO 1020 N Castle Heights Ave Ste A, Lebanon, TN 37087

Clarksville, TN-Gracey Ave IdentoGO 621 Gracey Ave Clarksville, TN 37040

VECHS WAIVER AGREEMENT AND STATEMENT Volunteer & Employee Criminal History System

for Criminal History Record Checks

under the National Child Protection Act of 1993, as amended

BI-xxxxRDA

Pursuant to the National Child Protection Act of 1993, as amended, 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 under these laws.

I hereby authorize (enter Name of Qualified Entity)_ TNCC19138 TSU TESS 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, 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 to deny me unsupervised access to children, the elderly, or individuals with disabilities. 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: TNCC19138 TSU TESS_

___________________________________________________________________________________ Name of Previous Qualified Entity: Year of Request: Address:City: State: Zip:

I have OR have not been convicted of a crime.

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

Contractor/Vendor

Date:______________

I am a current or prospective (check one):

Employee Volunteer

Signature:_______________________________________________

Printed Name:____________________________________________

Address: _________________________________________________

State:_______ Zip:___________ City: ___________________________________

Date of Birth: ___________________

ORIGINAL MUST BE RETAINED BY QUALIFIED ENTITY

TO BE COMPLETED BY QUALIFIED ENTITY:

Entity Name: _________________________________________________________________________

Address: ____________________________________________________________________________

City:____________________________________ State:_____ Zip: __________

Telephone:_______________________ Fax Number: ________________________

TBI Transaction Number: ____________________________

COPY MUST BE SUBMITTED TO TBI

AGENCY PRIVACY REQUIREMENTS FOR NONCRIMINAL JUSTICE APPLICANTS

Authorized governmental and non-governmental agencies/officials that conduct a national fingerprint-based criminal history record check on an applicant for a noncriminal justice purpose (such as employment or a license, immigration or naturalization matter, security clearance, or adoption) are obligated to ensure the applicant is provided certain notice and other information and that the results of the check are handled In a manner that protects the applicant's privacy. These obligations are pursuant to the Privacy Act of 1974, Title 5, United States Code (U.S.C.) Section 552a, and Title 28, Code of Federal Regulations (CFR), Section 50.12, among other authorities.

• Officials must provide to the applicant written notificationl 1 that his/her fingerprints will be used to check the criminal history records of the FBI.

• Officials must ensure that an applicant receives, and acknowledges receipt of, an adequate Privacy Act Statement when the applicant submits his/her fingerprints and associated personal information. 2

• Officials using the FBI criminal history record (if one exists) to make a determination of the applicant'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 update of 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 the criminal history record until the applicant has been afforded a reasonable time to correct or complete the record or has declined to do so.

• Officials must use the criminal history record solely for the purpose requested and cannot disseminate the record outside the receiving department, related agency, or other authorized entity.3

The FBI has no objection to officials providing a copy of the applicant's FBI criminal history record to the applicant for review and possible challenge when the record was obtained based on positive fingerprint identification. If agency policy permits, this courtesy will save the applicant the time and additional FBI fee to obtain his/her record directly from the FBI by following the procedures found at 28 CFR 16.30 through 16.34. It will also allow the officials to make a more timely determination of the applicant's suitability.

Each agency should establish and document the process/procedures it utilizes for how/when it gives the applicant notice, what constitutes "a reasonable time" for the applicant to correct or complete the record, and any applicant appeal process that is afforded the applicant. Such documentation will assist State and/or FBI auditors during periodic compliance reviews on use of criminal history records for concriminal justice purposes.

Sign & Date Here that you have read and understand the Privacy ACT

1 Written notification includes electronic notification, but excludes oral notification. 2 See https://www.fbi.gov/ services/ cjis/ comp a ct-council/privacy-act-statement 3 See 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) and 906.2(d).