New Substitute Paraprofessional or Secretary Fingerprint-Based Criminal Background Check Procedures

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2 New Substitute Paraprofessional or Secretary Fingerprint-Based Criminal Background Check Procedures You are required to have a fingerprint-based criminal history check. The Tazewell Regional Office of Education (ROE) is authorized to conduct fingerprint-based criminal history checks for the substitute teachers and multi-district hires. 1. Pekin School District 108 will make an appointment for fingerprinting at the Regional Office of Education, 414 Court Street, Pekin. You will need to come to the Administration Office located at 501 Washington St., Pekin to set this up. 2. Complete the Fingerprinting Disclosure and Authorization form. Print all information legibly in BLACK ink and bring this form with you to the Administration Office. *When you come to the administration office, you will receive your copy of the Summary of Your Rights Under the Fair Credit Reporting Act. You must have a PHOTO ID. The ROE will accept a driver s license, State ID, Military ID, Student ID and FOID card. 3. The ROE will process your fingerprints and complete the Tazewell Substitute Teacher Receipt and Authorization for Release of Criminal History Record Check form and provide you with a copy. The ROE will: submit your fingerprints to the Illinois State Police and Federal Bureau of Investigation. receive and review your ISP and FBI criminal history check reports. look for your name on the Illinois State-wide Sex Offender data base and Illinois State-wide Child Murderer and Violent Crimes Against Youth data base. issue a Criminal Background Report to District 108 containing your ISP and FBI results and notation that your name does not appear on either statewide data base. 4. You will return to the District 108 Office: the completed, stamped COPY of the Fingerprinting Disclosure and Authorization form c:mydocuments.substitutes.fingerpringbasedcriminalbackgroundcheckprocedures_subparaproorsec Updated April 2018

3 Pekin #108 DISCLOSURE AND AUTHORIZATION FOR CONSUMER REPORTS (BHR Fingerprint - School) Disclosure Pekin #108 has contracted with Bushue Background Screening in connection with my application for employment (including contract or volunteer services), I understand consumer reports will be requested by you ( End-User ). These reports may include, as allowed by law, the following types of information, as applicable: names and dates of previous employers, work experience, education, accidents, licensure, credit (as allowed by law where required, you will be presented with additional disclosures), etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, judgments, evictions, criminal records, etc., from federal, state, and other agencies that maintain such records. If I am hired, I understand that my employer can use this disclosure and authorization to continue to obtain such consumer reports throughout my employment, contract period or volunteer service. Authorization I,, hereby authorize procurement of consumer report(s) and investigative consumer report(s) by End-User. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for End-User to procure such reports at any time during my employment, contract, or volunteer period. I authorize without reservation, any person, business or agency contacted by the consumer reporting agency to furnish the above-mentioned information. This authorization is conditioned upon the following representations of my rights: I understand I have the right to make a request to the consumer reporting agency: Bushue Human Resources, Inc. d/b/a Bushue Background Screening ( Agency ), 302 East Jefferson Avenue, Suite B, Effingham, IL 62401, telephone number (217) or toll free at (877) , upon proper identification, to obtain copies of any reports furnished to End- User by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on End-User s behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to End-User obtaining the above information from the Agency. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency. I may view the Agency s privacy policy at their website: I understand that if the End-User is located in California, Minnesota or Oklahoma, that I have the right to request a copy of any report End-User receives on me at the time the report is provided to End-User. By checking the following box, I request a copy of all such reports be sent to me. Check here: As a California applicant, I understand that I have the right under Section of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency s file for my review. I may obtain such information as follows: 1) In person at the Agency s offices, which address is listed above. I can have someone accompany me to the Agency s offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency s information with this third party; 2) By certified mail, if I have previously provided identification in a written request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me. I understand that if I am applying for employment in New York, that I have the right to receive a copy of Article 23-A of the New York Correction Law (initial if this applies). I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, th Ave, Ste. 2000, Seattle, Washington , (206) I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary of Rights (initials).

4 Pekin #108 (BHR Fingerprint - School) *Information is used for background screening purposes only. PLEASE PRINT LEGIBLY Applicant s Legal Name (full name) First: Middle: Last: Alias or Maiden Name First: Middle: Last: Home Address: Street Address: City: State: Zip: Date of Birth (MM/DD/YYYY): / / Phone Number: APPLICANT INFORMATION Social Security Number: - - Address: Place of Birth (state): Driver s License Number: State of Issuance: Gender: Male Female Race (Circle): Skin Tone (Circle): Eye Color (Circle): Hair Color (Circle): Height: Indian/Alaskan Asian Black Pacific Islander White/Caucasian Hispanic/Latino Unknown/Other Black Dark Brown Light Brown Fair Light Medium Olive Black Blue Brown Green Gray Hazel Other Bald Black Blonde Brown Gray Sandy Red ft. Weight in. Circle if applicable: Student Teacher Bus Driver Contractor Position Applying For (if contractor, list the name of your employer): APPLICANT SIGNATURE AND DATE Signature (if under the age of 18, parent/guardian signature is required): Date: Proof of Identity: Office Use Only: Bushue Background Screening ORI Number: DL State ID Passport Birth Certificate SSC Technician: Technician License Number: Regular: IL090108S TCN: Purpose Code: Date of Fingerprint: Time: Location: Payment Amount Payment Type: Cash M.O CC

5 PHYSICAL EXAMINATION RECORD According to state law, we must have a physical exam on file for you. The exam may not be made more than 90 days prior to your hire date. You will also need to have a Tuberculin Skin test or chest X-ray. The TB test or chest X-ray may not be made more than 90 days prior to your hire date. Options available if interested: IWIRC - Phone Physical $54.00 TB Test $11.25 Two locations: 736 SW Washington St., Suite 2A, Peoria 7725 N Knoxville Ave., Suite B, Peoria Tazewell County Health Department Phone TB tests: $21.00 fee for Tazewell County residents $31.00 for non-residents Monday, Tuesday, Wednesday, and Friday from 1:00 pm to 4:00 pm. Please call if you are interested in their services.

Pekin Public Schools District 108 501 Washington Street Pekin, Illinois 61554 309/477-4740 Fax 309/477-4701 Illinois State Board of Education U.S. Department of Education Race and Ethnicity Data Standards INSTRUCTIONS: Both questions must be answered.

13 Pekin Public Schools District Washington Street Pekin, Illinois / Fax 309/ Illinois State Board of Education U.S. Department of Education Race and Ethnicity Data Standards INSTRUCTIONS: Both questions must be answered. Part A asks about your ethnicity and Part B asks about your race. If you decline to respond to either question, the school district is required to provide the missing information by observer identification. Part A. Are you Hispanic/Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.) Choose only one. No, not Hispanic/Latino Yes, Hispanic/Latino The question above is about ethnicity, not race. No matter which answer you selected, continue and respond to the question below by marking one or more boxes to indicate what you consider your race to be. Part B. What is your race? Choose one or more. American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment.) Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.) Black or African American (A person having origins in any of the black racial groups of Africa.) Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.) White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.) Note: Data collected on this form must be maintained by the school district for three years. However, when there is litigation, a claim, an audit, or another action involving this record, the original responses must be retained until the completion of the action. Employee Signature Date Print Name Obtained from National Center for Education Statistics, Standard 1-5

Example Application DO NOT SUBMIT

Example Application DO NOT SUBMIT Supervised Agricultural Experience (SAE) Grant Application Grant Information Amount: $1,000.00 Applicant Information Last Name First Name FFA ID Gender DOB Dues Paid Contact Information Address City State