Livescan Waiver Form

LIVESCAN WAIVER AND SERVICE AGREEMENT

Client Name:

Requesting Agency/Employer:

Client Address:

Date of Birth:     Government ID (type and number):

WHEREAS

WHEREAS, the Client requires a criminal-background-based electronic fingerprint submission (Livescan) for the purpose of employment, licensure, or volunteer clearance and the Requesting Agency is responsible for facilitating such submission and transmitting required information to criminal justice agencies; and

WHEREAS, the Client requests a waiver of a new Livescan submission or certain Livescan services and/or agrees to alternate handling of the fingerprint submission, and the Requesting Agency is willing to process and submit, or to accept previously-submitted biometric results under the specific terms set forth in this Agreement; and

WHEREAS, both parties desire to set forth the scope of Livescan services, payment obligations, confidentiality protocols, and waiver and release terms in a written agreement.

SCOPE OF WORK

PAYMENT TERMS

Fee Amount (per submission): $

Late Fee: on overdue balances calculated from the original due date.

All fees paid to the Requesting Agency are non-refundable except as expressly provided in writing. The Client is responsible for fees charged by criminal justice agencies in connection with the Livescan submission if required.

WAIVER, AUTHORIZATION, AND ACKNOWLEDGEMENTS

The Client hereby acknowledges and agrees that the Requesting Agency shall proceed as follows (check applicable boxes):

  I waive the requirement for a new Livescan submission and authorize the Requesting Agency to use an existing prior fingerprint submission on file for the purpose(s) stated in this Agreement.

  I consent to the Requesting Agency capturing new electronic fingerprints on my behalf and transmitting those prints to the relevant criminal justice agencies.

The Client authorizes the release and exchange of criminal history information in connection with this Livescan submission to and from licensing, employing, or certifying agencies, and acknowledges that the Requesting Agency, while facilitating submission, does not control decisions of licensing or employing authorities.

The Client expressly waives any claim against the Requesting Agency for administrative decisions or adverse actions taken by third-party licensing or employment agencies that rely on processed criminal history information, except where such claim arises from the Requesting Agency's gross negligence or willful misconduct.

TERM AND TERMINATION

Term Commencement Date:     Term Expiration Date:

Either party may terminate this Agreement for convenience upon written notice provided at least days prior to termination. Termination does not relieve the Client of obligation to pay fees incurred prior to termination, including fees for submissions already processed.

CONFIDENTIALITY

The Requesting Agency will maintain personal and biometric information received from the Client in accordance with applicable privacy laws and industry protocols. Such information will be disclosed only as required by law or as necessary to effectuate the purposes of this Agreement, including transmission to criminal justice agencies and authorized licensing entities.

The Requesting Agency shall take commercially reasonable administrative, technical, and physical safeguards designed to protect the confidentiality and integrity of biometric and personal data while in the Agency's custody. The Client acknowledges that no electronic transmission can be guaranteed to be totally secure and accepts the limited risk inherent in electronic processing.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to that jurisdiction's conflicts-of-law principles.

ENTIRE AGREEMENT

This Agreement, including any written attachments expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, or understandings, whether written or oral. Any amendment or modification of this Agreement must be in writing and signed by authorized representatives of both parties.

CERTIFICATION AND REPRESENTATIONS

The Client represents and certifies under penalty of perjury that the information provided in this form is true and correct to the best of the Client's knowledge. The Client consents to the processing and release of criminal history information as necessary for the purposes stated herein.

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