Background Request Form (REVISED As of 09_11_.pdf

Office of Safety & Security Fingerprinting & Background Check Request Form (Updated, As of 9/11/2017)

Instructions: To enhance safety and security of APS students and staff, hiring managers, school administrators, program/project managers, and volunteer coordinators, etc. should complete this form to request fingerprinting and background check services authorizing: (1) issuance of an APS identification (ID) badge, and/or (2) controlled access to APS facilities for all prospective APS employees, contractors, volunteers, and district partners. All fields on the request form must be completed, reviewed, and approved by an authorized APS officer to ensure accurate and timely processing of requested services. To avoid safety risks, fingerprinting and background check, ID badging, and access control services will not be completed without proper, advanced approval of a completed request form. All completed, approved request forms should be submitted via email to: fingerprinting@atlantapublicschools.us at least 24-72 hours in advance of scheduled appointments/walk-in visits to maximize the customer service experience for every prospective APS employee, contractor, volunteer, and/or district partner.

Request Date: ____________ Requestor's Name: __________________________________ Title: _________________

Phone Number: (_____) ______-___________ Email Address: _______________________________________________

Division: ☐ Accountability & Information ☐ Finance ☐ General Counsel/Legal ☐ Human Resources ☐ Operations

☐ Schools & Academics ☐ Superintendent/Deputy Superintendent’s Office ☐ Atlanta Board of Education

☐ Other, please specify: ___________________ Department: ______________________________________

School Location Name: ______________________________________________________________________________

School Type: ☐ Traditional ☐ Charter (APS Property) ☐ Partner (APS Property) ☐ Other, please specify: __________________

APS Staff/Stakeholder Name: _________________________________________________________________________

Phone Number: (_____) _____-________ Email Address: ___________________________________________________

APS Staff/Stakeholder Status: ☐ Current APS Staff/Stakeholder ☐ Prospective APS Staff/Stakeholder

If “Current APS Staff/Stakeholder” complete the following fields:

o Current APS Title: _________________________________ Employee ID/Lawson Number: __________

If “Prospective APS Staff/Stakeholder” complete the following fields:

o Prospective APS Title: __________________________________ Hire/Start Date: __________________

Type of Fingerprinting & Background Check Request: (Select one.)

☐ Contractor ☐ District Partner ☐ New Hire/Prospective APS Employee ☐ Re-Certification/Renewal ☐ Volunteer

☐ Other, please specify: ____________________

Requested Services & Pricing: (Select all services that apply.)

☐ Fingerprinting & Background Check + APS Identification (ID) Badge – No Access Required 1 ($45)

☐ Fingerprinting & Background Check + APS Identification (ID) Badge – Access Required 2 ($45)

☐ Fingerprinting & Background Check Only 1 ($40) Re-Certification/Renewal; Prospective APS Staff/Stakeholders –No ID Badge/Access Control

☐ APS Identification (ID) Badge Only – Initial/First-time Badge – No Access Required 1 ($5)

☐ APS Identification (ID) Badge Only – Initial/First-time Badge – Access Required 2 ($5)

☐ APS Identification (ID) Badge Only – Replacement Badge 1 ($15) Current APS Staff/Stakeholders Replacing Initial/First-time ID Badge

☐ APS Alarm Access Code Required 3 (No Fee) Authorized APS Staff/Stakeholders Only

Authorized APS Supervisor’s Name: ______________________________________________ Title: __________________

Authorized APS Supervisor’s Signature: ___________________________________________ Approval Date: _________

Important Notes:

1 APS Staff/Stakeholders must bring the following items to complete requested services:

An unexpired form of photo identification. (e.g., acceptable forms of ID include: Driver’s License; State-Issued Identification Card; Permanent Resident Card, or U.S. Passport.)

All payments must be in the form of a money order or a cashier’s check made payable to: Atlanta Public Schools.

o Fingerprinting & Background Check and Identification (ID) Badge fees are the responsibility of the individual not APS.

o New pricing is effective as of Sunday, 10/1/2017.

o Currently no cash, credit card or personal check payments can be accepted; no exceptions.

2 APS Access Control Request Form must be completed, approved, and submitted by hiring managers, school administrators, program/project managers, volunteer coordinators, etc. to authorize access control updates for APS Staff/Stakeholders; see Supplemental Request Form A.

3 APS Alarm Access Code Form must be completed, approved, and submitted by hiring managers, school administrators, program/project managers, volunteer coordinators, etc. to authorize alarm access codes for designated APS Staff/Stakeholders; see Supplemental Request Form B.

mailto:fingerprinting@atlantapublicschools.us

APS Fingerprinting & Background Check Request Form