DPS Computerized Criminal History (CCH) Verification
I,_______________________________________ , acknowledge that a Computerized Criminal History (CCH) check may be performed by accessing the Texas Department of Public Safety Secure
APPLICANT or EMPLOYEE NAME (Please print)
Website and may be based on name and DOB identifiers. (This is not a consent form, but serves as information for the applicant.) Authority for this agency to access an individual’s criminal history data may be found in Texas Government Code 411; Subchapter F.
Name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history record information (CHRI), therefore the organization conducting the criminal history check is not allowed to discuss with me any CHRI obtained using the name and DOB method. The agency may request that I also have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search.
In order to complete the fingerprint process I must make an appointment with the Fingerprint Applicant Services of Texas (FAST) as instructed online at www.txdps.state.tx.us /Crime Records/Review of Personal Criminal History or by calling the DPS Program Vendor at 1-888-467-2080, submit a full and complete set of fingerprints, request a copy be sent to the agency listed below, and pay a fee of $25.00 to the fingerprinting services company.
Once this process is completed the information on my fingerprint criminal history record may be discussed with me.
(This copy must remain on file by this agency. Required for future DPS Audits)
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Signature of Applicant or Employee (optional)
___________________
Date
_________________________________________________________
Agency Name (Please print)
________________________________________________________
Agency Representative Name (Please print)
___________________________________
Signature of Agency Representative
____________________
Date
Please: Check and Initial each Applicable Space
CCH Report Printed:
YES_____ NO_____ _____initial
Purpose of CCH: ___________________________
Empl_____ Vol/Contractor______ ______initial
Date Printed: ________________ ______initial
Destroyed Date:______________ ______initial
Retain in your files
Rev. 09/2015