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 https://www.dps.texas.gov/section/crime-records/crime-records-general-information 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
___________________
Date
_________________________________________________________
Agency Name (Please print)
________________________________________________________
Authorized User: (Please print)
___________________________________
Signature of Authorized User
____________________
Date of Name-Based CCH Search
Please: Check and Initial each Applicable Space
Purpose of CCH: ___________________________
Empl_____ Vol/Contractor______ Other_____ ______initial
CCH Storage __No, CCH is not stored by agency ___Yes, CCH is stored by agency
Retention Period
__Temp Only __Annual __ None in Place __Not Applicable __Other:____
Storage Method
__ Physical /Printed __Digital / Electronic __ Not Applicable
Retention Purchase - Explain: ____________________________
Destroyed Date:______________ ______initial
Destruction Method of CCH: Explain:______________________
Retain in your files
Rev. 5/8/2024