VECHS APPLICANT WAIVER AGREEMENT AND STATEMENT
For Criminal History Record Checks
I hereby authorize Brevard Public Schools to submit a set of my fingerprints and this form to the Florida Department of Law Enforcement (FDLE) for the purpose of accessing and reviewing Florida and national criminal history records that may pertain to me. I understand that I would be able to receive any national criminal history record that may pertain to me directly from the Federal Bureau of Investigation (FBI). Pursuant to Title 28, Code of Federal Regulations (CFR), Sections 16.30-16.34 and that I could then freely disclose any such information to whomever I chose. By signing this Waiver Agreement, it is my intent to authorize the dissemination of any national criminal history record that my pertain to me to the Qualified Entity with which I am or am seeking to serve as a volunteer.
I understand that, my fingerprints may be retained at FDLE and the FBI for the purpose of providing any subsequent arrest notifications and that upon request you may provide me a coy of the criminal history record report, and that I am entitled to challenge the accuracy and completeness of any information contained in any such report. I am aware that procedures for obtaining a change, correction, or updating of the FDLE or FBI criminal history are set forth in F.S. 943.056 and Title 28, CFR, Section 16.34. I may obtain a prompt determination as to the validity of my challenge before you make a final decision about my status as an employee and/or volunteer.
A national criminal history record check has previously been requested by:
I have OR have not been convicted of a crime.
I do OR do not authorize you to release my criminal history records, if any, to other qualified entities.
BY MY SIGNATURE, I CERTIFY THAT I KNOW, UNDERSTAND, AND AGREE THAT ANY FALSE STATEMENT OR OMISSION OF INFORMATION REQUESTED WILL RESULT IN MY TERMINATION AS A SCHOOL VOLUNTEER. Volunteers are required to be fingerprinted within 30 days. Failure to be fingerprinted will terminate your application.