HR Fingerprint Instructions

HR FINGERPRINT INSTRUCTIONS

Purpose: These instructions explain the fingerprinting process required for employment-related background checks, the documentation you must present at the fingerprinting session, the uses of the fingerprint information, fee and appointment procedures, and your certifications and authorizations. Read carefully and complete the requested information below.

Personal Information

Date of Birth:    Last 4 of SSN:

Position Information

Employment History

Employer 1

Dates Employed: From to

Employer 2

Dates Employed: From to

Education

References

Reference 1

Reference 2

Reference 3

Fingerprint Appointment Details

Appointment Date:    Time:

Required Identification at Time of Service

You must present two forms of identification, one of which must be a government-issued photographic ID. Examples include a valid driver's license, state identification card, passport, or military ID. Present original documents; photocopies are not acceptable.

Fingerprint Procedure & Processing

The fingerprint collection will be performed using either a live-scan electronic capture or ink-and-card, at the discretion of the collecting agency. The prints and associated personal information are submitted to criminal history repositories for the limited purpose of determining suitability for employment or licensing. Processing times vary; you will be notified of the results according to employer procedures. The employer may rely on the results to make hiring or other determinations.

Privacy, Retention, and Use of Fingerprints

By signing below you authorize the collection and submission of your fingerprints and identifying information for the purpose described above. Collected data may be compared against criminal history records and may be retained by criminal justice agencies in accordance with their retention schedules. The employer will not use fingerprint data for unrelated employment decisions. Requests to obtain a copy of any record or to challenge the accuracy of a criminal history record must be submitted in writing to the agency that maintains the file; the employer will assist in facilitating such requests as required by law.

Fees, Refunds, Rescheduling and Cancellation

The fingerprinting fee is indicated above and is payable at the time of service unless otherwise authorized by the employer. Refunds will be issued only if the employer cancels the fingerprint requirement or if the fingerprinting agency fails to perform the service. Appointments must be rescheduled at least 48 hours in advance of the scheduled time to avoid forfeiture of any applicable fee.

Legal Disclosures

At-Will Employment: If you are offered employment, your employment will be on an at-will basis, which means either you or the employer may terminate the employment relationship at any time, with or without cause or prior notice, unless a written agreement signed by an authorized representative of the employer states otherwise.

Equal Opportunity: The employer provides equal employment opportunity to all applicants and employees without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other category protected by applicable law.

Authorization to Contact Previous Employers and Background Check Consent

I authorize the employer and its agents to contact and obtain information from my prior employers, educational institutions, licensing authorities, and references to verify the information I have supplied. I further authorize the submission of my fingerprints and identifying information for the purpose of obtaining state and national criminal history record information. I understand that any false statement, omission, or misrepresentation may disqualify me from consideration or lead to termination if discovered after hire.

Applicant Certification

I certify that all information provided in this form is true, correct and complete. I understand and agree that my fingerprints and other identifying information may be retained and used for identification and background screening purposes in accordance with applicable law and agency policy. I understand that a criminal record does not automatically disqualify me; rather, any conviction will be evaluated against job-related criteria.

Sign Now