2951_10.DOC
DOC document 117 KB Posted
- Contract number
- 505ENT-O13-FINGERPRIN-01
- Issued by
- Wisconsin
About this file
This document is a Waiver Agreement and Statement form (Appendix F, Bid #28094-CH) issued by the Wisconsin Department of Justice, Division of Law Enforcement Services, Crime Information Bureau, Record Check Unit. The form is designed for use by agencies seeking to conduct background checks on individuals through fingerprint submission to both the Wisconsin Department of Justice and the Federal Bureau of Investigation for criminal history record reviews.
The document establishes procedures for criminal background screening services rather than traditional goods or services procurement. It authorizes the dissemination of criminal history information to employing agencies, licensing bodies, or volunteer organizations for employment, licensing, or volunteer screening purposes. The waiver informs individuals of their rights to obtain copies of their criminal history records and to challenge accuracy or completeness of information, with FBI record correction procedures governed by 28 CFR 16.34. The form includes provisions allowing employers to refuse employment or licensing based on criminal charges or convictions that substantially relate to job responsibilities, while ensuring compliance with employment discrimination laws regarding arrest records.
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Other files
| File | Type | Posted |
|---|---|---|
| 2951_0.PDF | ||
| 2951_3.XLS | XLS spreadsheet | |
| 2951_8.DOC | DOC document | |
| 505ENT-O13-FINGERPRIN-01 AMENDMENT 3.pdf | ||
| Contract Amendment 4.pdf | ||
| 2951_15.PDF | ||
| 2951_2.PDF | ||
| 2951_5.XLS | XLS spreadsheet | |
| 2951_7.DOC | DOC document | |
| 11-99041-30 Contract Amendment 2 Blank.pdf | ||
| 2951_11.PDF | ||
| 2951_12.DOC | DOC document | |
| 2951_13.DOC | DOC document | |
| 2951_14.PDF | ||
| 2951_4.DOCX | DOCX document | |
| 2951_6.XLS | XLS spreadsheet | |
| 2951_9.DOCX | DOCX document | |
| WI Dept of Admin - Fieldprint Contract Amendment 5.pdf | ||
| 11-99041-300 Amendment 1.pdf | ||
| 2951_1.PDF | ||
| Fieldprint.pdf |
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Text version
STATE OF WISCONSIN
DEPARTMENT OF JUSTICE
Appendix F
Bid # 28094-CH
DIVISION OF LAW ENFORCEMENT SERVICES
P.O. Box 2688 Crime Information Bureau
Madison, WI 53701-2688 Record Check Unit
608/266-5764
WAIVER AGREEMENT AND STATEMENT
I hereby authorize the agency listed below to submit a set of my fingerprints to the Wisconsin Department of Justice and the Federal Bureau of Investigation for the purpose of accessing and reviewing Wisconsin and national criminal history records that may pertain to me.
By signing this waiver agreement it is my intent to authorize dissemination of such criminal history record information that may pertain to me to the agency with which I am employed, seeking employment with, seeking to serve as a volunteer for, or seeking licensure from. I also understand that this information may only be used for the purpose it was submitted.
I understand that it is not employment discrimination because of arrest record to refuse to employ or license, or to suspend from employment or licensing, any individual who is subject to a pending criminal charge or has been convicted of any felony, misdemeanor or other offense if the circumstances of the offense or charge substantially relate to the circumstances of the particular job or licensed activity.
I have been informed of my right to obtain a copy of the criminal history records, if any, and of my right to be given a reasonable amount of time to challenge the accuracy and or to complete any information contained in the criminal history record. The procedures for obtaining a change, correction, or updating of an FBI identification record are set forth in the Code of Federal Regulations (28 CFR 16.34).
Name:____________________________________________________________________________________ Address:__________________________________________________________________________________ Date:_____________________________ Signature:_____________________________________________ Witness:__________________________________________________________________________________ Name of Agency: ___________________________________________________________________________________ Agency Address: ___________________________________________________________________________________ � EMBED Word.Picture.8 ���
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