Volunteer Application Form

DPS Computerized Criminal History (CCH) Verification

(AGENCY COPY)

I,   , acknowledge that a Computerized Criminal History (CCH) check may be performed by accessing the Texas Department of Public Safety Secure 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 www.txdps.state.tx.us.

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 Crime Records General Information | Department of Public Safety (texas.gov) 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. Acknowledge by signing below.

(Agency to retain this CCH Verification Form for DPS auditing purposes.)

Applicant Information
Signature must match applicant name
Additional Information

Important Information:

I understand and agree that SISD may obtain any criminal history record information pertaining to me. The district may obtain such information from the Department of Public Safety. Have you received a deferred adjudication or been convicted by federal, state, or other law enforcement authorities or pleaded nolo contendre for violation of federal law, state law, county or municipal law, regulation or ordinance? (You must include any offense for which a fine of $100.00 or more was imposed. Do not include any offense that occurred before your eighteenth birthday.)

Comprendo y acepto que el Distrito de Socorro puede obtener cualquier información e historial criminal relativo a mí. El Distrito puede obtener cualquier información del Departamento de Seguridad Publica. ¿Ha recibido una sentencia diferida o fue condenado por las leyes federales, estatales o de otros servicios de seguridad o se declaró nolo contendere por la violación de la ley federal, la ley estatal, del condado o municipal, regulación u ordenanza? (Usted debe incluir cualquier delito por el cual se impuso una multa de $100.00 o más. No incluya ninguna infracción cometida antes de sus 18 años.)

Student Information
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By clicking the Submit button above, I hereby give my voluntary consent to a criminal history check, pursuant to Texas Education Code §22.0835. I understand that certain information obtained as a result of this criminal history check may preclude my participation in the SISD volunteer program. I agree to conform to all district policies and procedures. I certify that all the information in this application is true and correct, and I further understand that my misstatement or omission of information may be grounds for disqualification. I understand this application becomes public record and is subject to disclosure. I understand that I have the right to review and challenge any negative information that would adversely impact my application. Further, I hereby hold harmless, release, and fully discharge SISD, its agents, officers, or employees, from any and all liability, and claims, causes of action, costs and expenses which be attributed to my participation in the SISD Volunteer Program and/or any and all liability for the criminal history check and any action as a result of information obtained through the criminal history investigation. Por lo presente doy mi consentimiento voluntario a una verificación de antecedentes penales, de conformidad con el Código de Educación de Texas § 22.0835. Yo entiendo que cierta información obtenida como resultado de esta verificación de antecedentes penales puede impedir mi participación en el programa de voluntariado SISD. Estoy de acuerdo en cumplir con todas las políticas y procedimientos del distrito.

I understand and agree that SISD may obtain any criminal history record information pertaining to me. The district may obtain such information from the Department of Public Safety. Have you received a deferred adjudication or been convicted by federal, state, or other law enforcement authorities or pleaded nolo contendre for violation of federal law, state law, county or municipal law, regulation or ordinance? (You must include any offense for which a fine of $100.00 or more was imposed. Do not include any offense that occurred before your eighteenth birthday.) Comprendo y acepto que el Distrito de Socorro puede obtener cualquier información e historial criminal relativo a mí. El Distrito puede obtener cualquier información del Departamento de Seguridad Publica. ¿Ha recibido una sentencia diferida o fue condenado por las leyes federales, estatales o de otros servicios de seguridad o se declaró nolo contendere por la violación de la ley federal, la ley estatal, del condado o municipal, regulación u ordenanza? (Usted debe incluir cualquier delito por el cual se impuso una multa de $100.00 o más. No incluya ninguna infracción cometida antes de sus 18 años.)