Attachment 6 - Exhibit 1.pdf

EXHIBIT 1

Submitting a Criminal History Summary Check

Step 1: Complete the Applicant Information Form.

• The “Mail Results to Address” should be to SFS and not the applicant.

• The FBI will return all results by U.S. First-Class Mail via the United States Postal

Service.

Step 2: Obtain a set of fingerprints.

• An original fingerprint card needs to be submitted to the FBI via mail. All information blocks that have been highlighted need to be filled out. The ones in yellow should be completed by the applicant and the ones in green by the agency taking fingerprints.

• If possible, the fingerprints should be taken by a fingerprinting technician. This service may be available at a law enforcement agency. Locally they can be done through Security Forces ($0.00).

• Fingerprints taken with ink or via live scan are acceptable.

• Note: If fingerprints are not legible, the fingerprint card will be rejected. This could cause delays in processing and could also result in additional fees. Normally fingerprints taken with a digital finger printer are accepted.

Step 3: Submit payment.

• Option 1: Pay by credit card using the Credit Card Payment Form. Don’t forget to include the expiration date of the credit card that is used.

• Option 2: Obtain a money order or certified check for $18 U.S. dollars made payable to the Treasury of the United States. Please be sure to sign where required.

• Important note: Cash, personal checks, or business checks WILL NOT be accepted and sending any of these will delay processing of the request.

• Payment must be for the exact amount.

• If the submission is for multiple background checks, include $18 for each person.

• If the request is for multiple copies per person, include $18 for each copy requested.

Step 4: Review the Criminal History Summary Request Checklist to ensure that everything is included that is required to process the request.

Step 5: Bring all the required items (signed applicant information form, fingerprint card, and payment of $18 U.S. dollars for each person or copy requested) to the COR Office (bldg. 358).

They will mail the package to the following address:

FBI CJIS Division – Summary Request 1000 Custer Hollow Road Clarksburg, WV 26306

Note: The processing time is currently 22 calendar days due to the volume of requests received.

Please allow additional time for mail delivery. The FBI requests a minimum of six weeks from submission before calling them to check on the status of the request. For assistance, contact the Customer Service Group at (304) 625-5590.

https://forms.fbi.gov/criminal-history-summary-checks-review/ http://www.fbi.gov/about-us/cjis/criminal-history-summary-checks/credit-card-payment-form http://www.fbi.gov/about-us/cjis/criminal-history-summary-checks/criminal-history-summary-request-checklist

I-783 (Rev. 7-1-2013) OMB-1110-0052

PRIVACY ACT STATEMENT

The FBI’s acquisition, retention, and sharing of information submitted on this form is generally authorized under 28 USC 534 and 28 CFR 16.30-16.34. The purpose for requesting this information from you is to provide the FBI with a minimum of identifying data to permit an accurate and timely search of criminal history identification records. Providing this information (including your Social Security Account Number) is voluntary; however, failure to provide the information may affect the completion of your request. The information reported on this form may be disclosed pursuant to your consent, and may also be disclosed by the FBI without your consent pursuant to the Privacy Act of 1974 and all applicable routine uses. Under the Paperwork Reduction Act, you are not required to complete this form unless it contains a valid OMB control number. The form takes approximately 3 minutes to complete.

Applicant Information * Denotes Required Fields *Last Name *First Name Middle Name 1 Middle Name 2

*Date of Birth: *Place of Birth: U.S. Citizen or Legal Permanent Resident:

Yes No

*Country of Citizenship: Country of Residence: Prisoner Number (if applicable):

*Last Four Digits of Social Security Number:

*Height: *Weight:

*Hair (please check appropriate box):

Bald Black Blonde/Strawberry Blue Brown Gray Green Orange Pink Purple Red/Auburn Sandy Unknown White

*Eyes (please check appropriate box):

Black Blue Brown Gray Green Hazel Maroon Multicolored Pink Unknown

Applicant Home Address *Address

*City *State *Postal (Zip) Code *Country Phone Number E-Mail

Mail Results to Address

C/O ATTN

Address

City State Postal (Zip) Code Country Phone Number (if different from above)

Payment Enclosed: (please check appropriate box)

CERTIFIED CHECK MONEY ORDER CREDIT CARD FORM

Reason for Request:

Personal review Challenge information on your record Adoption of a child in the U.S.

International adoption Live, work, or travel in a foreign country Other

* APPLICANT SIGNATURE DATE

Mail the signed applicant information form, fingerprint card, and payment of $18 U.S. dollars to the following address:

FBI CJIS Division – Summary Request 1000 Custer Hollow Road

Clarksburg, West Virginia 26306

You may request a copy of your own Criminal History Summary to review it or obtain a change, correction, or an update to the summary.

1-786 (1-31-10)

Credit Card Payment Form

* Denotes Required Fields

Applicant Name

* Name (as it appears on credit card) Company Name (if applicable)

* Billing Address Billing Address 2

* City

* State/Province

* Postal (ZIP) Code

* Country

* Credit Card #:

* Expiration Date (MM/YYYY)

* Total Amount To Be Billed To Credit Card $ ( x $18 US Dollars Per Request)

* Card Holder Signature

No Charge Backs or Refunds All Sales Final

1-785 (Rev. 5-1-2013)

Did You Remember To...?

Please check the boxes to ensure that you have included everything needed to process your request.

Include a completed application form.

Sign your application. Note: If for a couple, family, etc., all must sign the application.

Include a completed fingerprint card. A completed fingerprint card includes the following:

1. Name

2. Date of Birth

3. Descriptive Data

4. All 10 rolled fingerprint impressions.

5. The plain impressions including thumbs of both hands.

6. Current fingerprint card-no older than 18 months.

Include a credit card payment form, certified check*, or money order for $18.00 per request. Note: This amount must be exact.

If using a credit card, please ensure the credit card payment form is filled out completely.

Don’t forget to include the expiration date of the credit card that you are using.

If paying with a certified check or money order, make it payable to the Treasury of the United States.

CASH OR PERSONAL/BUSINESS CHECKS

ARE NOT AN ACCEPTED FORM OF PAYMENT.

Include a form of contact information (i.e., e-mail, telephone number) in case we need to contact you.

*To issue a certified check, the bank verifies that sufficient funds exist in the requestor’s account to cover the check and so certifies payment at the time the check is written. Those funds are then set aside in the bank’s internal account until the check is cashed or returned to the payee.