ࡱ> *,) bjbjO O 4@-a-a $$$$$8888,d8e!fphhh   $"}% !$ !$$h!LLLX$h$ L LLLhh  )HL 5!0e!L3&d3&L3&$LL6LS,q ! !Xe!3& : DPS Computerized Criminal History (CCH) Verification (AGENCY COPY) I,  CONTROL Forms.TextBox.1 \s  , acknowledge that a Computerized Criminal APPLICANT or EMPLOYEE NAME (Please print) History (CCH) check will be performed by accessing the Texas Department of Public Safety Secure Website and will be based on name and DOB identifiers I supply. (This is not a consent form.) Authority for this agency to access an individuals 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, therefore the organization conducting the criminal history check is not allowed to discuss with me any criminal history record information obtained using this method. The agency may request that I have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search. Once this process is completed the information on my fingerprint criminal history record may be discussed with me. In order to complete the process I must make an appointment with the Fingerprint Applicant Services of Texas (FAST) as instructed online at  HYPERLINK "http://www.txdps.state.tx.us" 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 $24.95 to the fingerprinting services company. (This copy must remain on file by your agency. Required for future DPS Audits) ___________________________________ Please:Check and Initial each Applicable SpaceCCH Report Printed:YESNOinitialPurpose of CCH:EmplVol/ContractorinitialDate Printed: /initialDestroyed Date:initialRetain in your files Signature of Applicant or Employee  CONTROL Forms.TextBox.1 \s  Date  CONTROL Forms.TextBox.1 \s  Agency Name (Please print)  CONTROL Forms.TextBox.1 \s  Agency Representative Name (Please print) ___________________________________ Signature of Agency Representative  CONTROL Forms.TextBox.1 \s  Date Rev. 09/2013 56CDEFJKghijlmx> J K W ösoko`X`QoIEh~hB$hI(>* hphI(h/?yCJaJh&OhI(CJaJh$h  jh"17hI(>*U*jh"17h Jo>*Uj=V h JoCJUVaJh"17hI(>*jh"17hI(>*UhI(h$h5B*ph333hI(5B*ph333h$h/?y5B*ph333h$hI(5B*ph333h&hI(5CJaJh|*hI(5CJaJ56EF 3 a$dh$&`#$/Ifa$gdF- $ Pa$gdI( $da$gdI($dh`a$gd$dh`a$gd T$dh`a$gd $dha$gd$a$gdI( W ` a b | ~      " # ' / 2 > E F L 3 4 J K c d n o    4 5 C ] m Ļ賫裛h TCJaJh$CJaJh Th6h Thoj6h60hoj0JjhojUh.{hO5hO5>*hO5hxhI(>*h~hojh Th$hh/?yhI(= !?V^_`aXYZpqr÷um^j=V h JoCJUVaJh"17hI(>*jh"17hI(>*Uh XhI(CJaJh}nhI(CJaJh}nhI(5CJaJh/?yCJaJh}nhI(CJaJh}nhI(5CJaJh}nhI(5CJaJh)2AhI(5hI(5CJaJh ZhI(5CJaJh Zh T5CJaJhI(hO5$r$dh$&`#$/Ifa$gdF-tkdi$$Iflk t 6`044 laytF-udh$&`#$/IfgdF-tkd$$Ifl t 6`044 laytF-udh$&`#$/IfgdF-tkd$$Ifl  t 6`044 laytF-udh$&`#$/IfgdF-tkd%$$Ifl t 6`044 laytF-q\q\\\\dh$&`#$/IfgdF-dh$&`#$/If]gdF-tkd$$Ifl t 6`044 laytF-kdM$$Ifl:֞d ~ t 6`044 laytF-u\dh$&`#$/If]gdF-tkd$$Ifl t 6`044 laytF-dh$&`#$/IfgdF-dOdh$&`#$/IfgdF-kd$$IflFtT  t 6`0    44 laytF-q\C\\\dh$&`#$/If]gdF-dh$&`#$/IfgdF-dh$&`#$/If]gd/?ytkd$$Ifl t 6`044 laytF-dh$&`#$/IfgdF-kdu$$Ifl:֞*  t 6`044 layt/?y-.012:u\dh$&`#$/If]gdF-tkd$$Ifl t 6`044 laytF-dh$&`#$/IfgdF-:;<>)dh$&`#$/IfgdF-kdK $$Ifl:r&  t 6`044 laytF-<=MNOPXq\GGGdh$&`#$/IfgdF-dh$&`#$/Ifgdldh$&`#$/If]gdF-tkdA $$Ifl  t 6`044 laytF-XYZ>)dh$&`#$/IfgdF-kd $$Ifl.r4  t 6`044 laytF-Z[pqrr$dh$&`#$/Ifa$gdF-tkd $$Ifl: t 6`044 laytF-qr)Uzwlwwwwl $dha$gdI($a$gdI( $da$gdI(tkde $$IflY t 6`044 laytF-  %&'()FUVyz˼檢Ӣ˓檢ӂނvgZӢjh"17h Jo>*Uj=V h JoCJUVaJh XhI(5CJaJhI(jh"17h Jo>*Uj=V h JoCJUVaJhI(CJaJ hI(>*jSh"17h Jo>*Uj=V h JoCJUVaJh"17hI(>*h XhI(CJaJh)2AhI(5jh"17hI(>*Uj h"17h Jo>*U"hI(hz,CJaJh CJaJh/?yCJaJ21h:pF-/ =!8"8#$% iDd hb  c $A? 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