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How do I fill this out?

To fill out this form, you need to provide your name, signature, and date. You should read and understand the privacy policies provided by the Florida Department of Law Enforcement and the FBI. Once the form is completed, follow the instructions for submission.

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How to fill out the Privacy Policy Acknowledgement and Criminal Record Notice?

  1. 1

    Read the provided privacy policies.

  2. 2

    Enter your name in the Employee/Contractor Name field.

  3. 3

    Sign the form in the Employee/Contractor Signature field.

  4. 4

    Write the date in the Date field.

  5. 5

    Submit the form according to the provided instructions.

Who needs the Privacy Policy Acknowledgement and Criminal Record Notice?

  1. 1

    Applicants for employment who need to submit their fingerprints for a background check.

  2. 2

    Volunteers seeking to work with children, the elderly, or persons with disabilities.

  3. 3

    Contractors who require approval to work with specified agencies.

  4. 4

    Individuals applying for licensing that requires a criminal background check.

  5. 5

    Anyone seeking to review and challenge their own criminal history record.

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    Open the PDF editor tool.

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    Add or modify text in the designated fields.

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What are the instructions for submitting this form?

To submit this form, ensure all required fields are completed. Submit the form through the appropriate online submission system or email it to the designated agency address provided by your employer or licensing body. You may also fax the form to the agency's fax number or mail it to the physical address listed in the submission instructions. It is important to consult with the requesting agency to confirm the preferred method of submission.

What are the important dates for this form in 2024 and 2025?

There are no specific annual deadlines for submitting this form. Be sure to check with the specific agency or organization requiring the form for their submission timeline.

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What is the purpose of this form?

The purpose of this form is to acknowledge receipt of privacy policies from the Florida Department of Law Enforcement and the Federal Bureau of Investigation. This form is used to inform applicants submitting fingerprints for background screening about the exchange and retention of their criminal history records. It also outlines their right to challenge an incorrect criminal history record and ensures compliance with privacy guidelines.

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Tell me about this form and its components and fields line-by-line.

This form includes several fields that need to be completed for accurate record-keeping and compliance.
fields
  • 1. Employee/Contractor Name: Enter the full name of the employee or contractor as printed.
  • 2. Employee/Contractor Signature: Provide the signature of the employee or contractor to acknowledge receipt of the privacy policies.
  • 3. Date: Indicate the date on which the form is being signed.

What happens if I fail to submit this form?

Failure to submit this form may result in delays or denial of approval to work with specified agencies. It is crucial to comply with the submission requirements to avoid any issues.

  • Denied Employment Approval: You may be denied the approval to work with specific agencies due to incomplete background screening.
  • Delayed Processing: There may be delays in processing your application, affecting your employment or volunteer opportunities.

How do I know when to use this form?

Use this form when you are required to submit fingerprints for background screening as part of employment, volunteering, or licensing processes.
fields
  • 1. Employment Applications: For submitting fingerprints as part of the employment application process.
  • 2. Volunteer Positions: When applying to volunteer with children, the elderly, or persons with disabilities.
  • 3. Contractor Approval: To gain approval to work with specific agencies under contract.
  • 4. Licensing Applications: As part of the requirements for obtaining a license that necessitates a background check.
  • 5. Record Review: To request a review and challenge of your own criminal history record.

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Privacy Policy Acknowledgement and Criminal Record Notice

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