Level 2 Background Screening Services

Transcription

1 Level 2 Background Screening Services LIVE SCAN VALIDATION FORM OFFICE USE:>>>>Submitted date: Photo Upload Date: FORM B Updated 11/8/2016 FDLE Required Information.. Complete ALL Items if Not Applicable put N/A..PRINT WITH CARE and VERY CLEARLY. DATE: TCN#: (Office Use) 70CA91 First Name: Address: Middle Name: City: Last Name: State: Zipcode Name Suffix: (if any) Phone: Address: Allias: Social Security #: Gender: Male / Female Race: White / Black / American Indian / Alaskan Native / Other Verbally Give This to Tech Verbally Give This to Tech Date of Birth: Height: Weight: Eye Color: Hair Color: Occupation: Place of Birth: ( State/Country)Citizenship: (Country) Reason for Fingerprints: Employer / Agency Requesting Screening: Address: CITY: State: ZIP: PHONE #: FAX#: AHCA PHOTO UPLOAD REQUIRED: Yes / No AHCA Screening Request ID#: ORI#: REQUIRED (State Agency ID#) OCA#: (Agency id# <<Leave Blank if unknown>>) (350623) I agree to have Level2 Background Screening Services LLC (Level2) perform a livescan of my fingerprints and to submit the above information and my finger prints to the Florida Department of Law Enforcement and the above listed controlling agency VIA the ORI# or OCA#. I hold harmless Level2 Background Screening Services and its affiliates for any errors or omissions in performing this screening and for any results of the screening services. I understand that Level2 utilizes the information provided on this form to submit to the FBI and FDLE. Level2 is NOT responsible to verify the validity of the information provided, just to provide a submission utilizing the information provided on this form. It is up to the customer listed herein to provided accurate information. The customer understands that Level2 has a NO REFUND POLICY. The person completing this form affirms that the screening information is there own personal information. Level2 does not do THIRD PARTY authorizations for screening purposes. I hold harmless Level2 Background Screening Services LLC and its affiliates for any errors or omissions in performing this screening and for any results of the screening services. X Signature Date Total FEE: $ Credit Card: Cash: Other

2 Level2 Background Screening Services LLC Confirmation of Level2 Submission FORM C Updated 11/8/2016 Level2 Screening Date: TCN#: Individual Name: Employer Name: Address: State Agency: ORI: OCA#: AHCA CLEARING HOUSE PHOTO TAKEN: YES NO PLACE DRIVERS LICENSE HERE AND MAKE 2 PHOTO COPIES ONE FOR CLIENT AND ONE FOR OFFICE It is the responsibility of the employer to retrieve the screening results of the Level2 LiveScan Screening FROM the appropriate state agency website portal. Level2 Background Screening Services LLC does NOT receive any result information. Screenings EXPIRE in 30 days if State application or licensee information is NOT on file with the appropriate State Agency. It is the responsibility of the applicant to provide accurate information for the Level2 Screening. If incorrect information is provided, the applicant MAY be required to pay again and re-screen. Applicants can CHECK to see the status of their screening on FDLE s website by entering the above noted TCN# at the following website:

3 Level 2 Background Screening Services 4910 Dyer Blvd West Palm Beach, FL Phone: Fax: THE AHCA LiveScan Process AHCA Screening Process Overview Employers send their employees, potential employees, or contractors to a LiveScan vendor for fingerprinting it is critical that the fingerprint submission is accompanied by the required information for the person screened (see LiveScan Vendor Requirements ). Failure to submit this information may result in the provider s inability to obtain screening results. Once prints are successfully submitted to FDLE, they will check the state criminal history repository for records and the FBI will check national criminal history systems for information. Allow 2-3 business days for FDLE/FBI processing and submission of results to AHCA. Once complete, FDLE electronically sends results to AHCA where data is brought into the AHCA Background Screening Database (BGS Database). AHCA staff review the results and determine if any disqualifying criminal offenses exist. If the person has disqualifying offenses, he/she is recorded in the AHCA Background Screening Database as Not Eligible, if no disqualifying offenses exist they are recorded as Eligible. The results of the screening are posted immediately to the Agency s Background Screening Results Website. Please allow 2-3 business days for AHCA processing. Therefore, total processing time is generally 5-7 business days from the date prints are submitted to FDLE. Level 2 screening records and confidential and may not be shared with anyone other than the individual that was screened. If a criminal record is incomplete, AHCA will contact the person screened through certified mail (based on the address submitted to FDLE) for additional information, which will delay the processing of the screening. The employer (AHCA provider/facility) should contact the person screened if delays exist. If fingerprints are rejected by FDLE/FBI, AHCA will send the person screened a certified letter directing them to return to the same vendor with a copy of the letter they received. The letter includes their TCR number. This number lets the vendor know that the first set of prints were rejected and to submit a second set of prints at no charge. The vendor must allow the person to submit a second set of fingerprints to FDLE at no additional cost. If the certified letter is not signed for after 30 days, a second letter will be sent out by regular mail. AHCA Background Screening Results Website The Agency s Background Screening Results Website provides direct access electronic screening results to licensed providers and registered third party vendors and health care contractors. This website enables users to search criminal history screening results of persons required to be screened for licensure and potential employees/contractors screened through the Agency and the Department of Health. These are the only two state agencies whose results will be reported on this site. Each licensed provider will receive a user code upon licensure to access the system, and must complete a User Agreement. New licensure applicants will receive an account by mail, once their initial license application is received by the Agency. Third Party Screening Entities and Health Care Contractors may also submit screenings and review screening results processed through the Agency. To gain access to the system, Third Party Screening Entities and Contractors must register with AHCA to obtain a AHCA #. Send a request by fax, mail, or on company letterhead to the Background Screening section at 2727 Mahan Drive, MS 40, Tallahassee, FL 32308, fax # (850) , or BGScreen@ahca.myflorida.com. Please include a phone number or address in the request. You will be contacted once the account is set up and given your AHCA #. Once you receive this number you will be able to log into the Agency s secure website and complete a user agreement. We have received a large number of screening results from LiveScan vendors submitted since August 2, 2010, that do not contain a Social Security Number for the person who was screened. Without the Social Security Number we cannot post the screening results in the AHCA Background Screening Results Website. If you have checked the AHCA Background Screening Results Website and are unable to find screening results of a LiveScan screening submitted more than 7 days ago, the Social Security Number may be missing. To correct, please fax the Names, Dates of Birth and Social Security Numbers for each missing screening result to: (850) Results will be corrected and posted to the AHCA Background Screening Results Website. Please be sure that all future screening candidates provide their Social Security Numbers at the time their prints are scanned. Thank you for your assistance. Prior Screening Conducted by another Agency or AHCA Proof of compliance with level 2 screening standards for the following state agencies is satisfactory compliance with screening for AHCA if the screening is less than five years old, the final screening determination is provided, the person has not been unemployed for more than 90 days (type of employment is not specified), and the person signs the Affidavit of Compliance with Background Screening [Reference (2)]

4 Level 2 Background Screening Low Screening Score Statement APPOINTMENT DATE: Applicant: Level2 Background Screening Services utilizes the latest equipment in Live-Scan technology. The system that we utilize to scan your finger prints is very expensive and is considered the best in the industry. Unfortunately, some customer s fingerprints are not easily readable due to life experiences. Finger prints can, over time, diminish in quality due to age or the job that you do. Our system scores each print scanned. If you receive a D or an E score, there is a chance that the FDLE or FBI will reject your scans. It is not uncommon. Unfortunately it may delay your clearance. If your fingerprints are rejected, you will receive a certified letter from the federal or state agency that has rejected your prints. Simply bring the letter back to us, and we will re-run another set of fingerprints. When we re-submit the prints with a certified letter resubmission code, an actual human being will review your prints and process the screening making an additional screens unnecessary. You are receiving this letter because of the scores that were generated during your screening process. Your scans may or may not be accepted by the FDLE or the FBI due to the scores that were generated from the Live-Scan system. Unfortunately, we are required to follow the steps outlined by FDLE. If the first scan is not accepted, you will be required to return and have your print s run a second time. There is no cost for the second run. Additionally, you will only be required to return one time to have your prints re-run. These are the guidelines set by the State of Florida Department of Law Enforcement. Level2 Background Screen Services is not responsible for the quality of an individual s fingerprints due to life experiences, however; we will re-run the second set of prints at no additional charge. We ask that you contact us if you do receive a certified letter rejecting your finger print scan. Applicant Signature DATE

5 Level 2 Background Screening Information about your Level II Livescan Screening WELCOME!!! You are visiting one of our Level2 Background Screening Services LLC locations because your employer or licensing agency is requesting that you have a Level II background screening performed. Our company has been performing screening services for applicants in Florida since We screen for almost all employment sectors and licensing boards in Florida. All we need is an ORI#, which is a FLORIDA assigned number designating your employment industry or licensing board. When we enter your personal information into a secure submission system, along with your scanned fingerprints, that information is sent to the Florida Department of Law Enforcement for review. FDLE then sends your data to the FBI for review, hence two levels of screening. Once completed, your results from these reviews are sent to the licensing board or employment sector as designated by the ORI# that you give us. Results ARE NOT sent to us. We never see them. It can take up to 7 to 14 days for your screenings to be processed by the FBI and FDLE. In most cases though, processing is completed in around 3 days. The screening process itself takes about 20 minutes, depending on the quality of your fingerprints. It is a matter of fact that younger applicants fingerprints scan better than older applicants. As we age, work, and use our hands, many of us loose the structure of our fingerprints. If your fingerprints do not scan well into our digital system, pour quality prints can delay the finalization of results. THERE IS NO other way of submitting fingerprints through the State of Florida background screening program. They require us to scan your fingerprints and submit them electronically. We do experience those applicants that have bad finger prints due to many reasons. If your prints are in pour condition, you may be notified by the FBI or FDLE to return to our facility to have your fingerprints run a second time. There is NO COST for this second run, HOWEVER, you must have them re-done within 14 days of notification that your prints are pour quality, DO NOT DELAY. This happens rarely, but you do need to be informed that this does occur. If your finger prints are "SCORING" during scan in the "D" and "F" scoring range, you may have to have your screening done a second time at no additional cost. We can not fix your fingers once worn. It is just a process that the FBI now requires to verify who you are. If your screening scores range "A" "B" and "C" you most likely will not have any issues and will not be requested to re-screen. When we call you into the lab to run your fingerprints, we ask that you review ALL INFORMATION entered into our system VERY CAREFULLY for errors. This information can only be submitted to the FDLE and FBI one time. If it is wrong, your results will not be connected to you and you will have to be rescreened at an additional cost. Your date of birth and SS# will be entered during the screening process. You can watch the information being entered for accuracy. We do not want this vital information on your application sheet. We ask that you present a copy of your driver's license to confirm that you are the person being screened. Show the screening your driver's license. If the address on your driver's license does not match the information on your application, we will need to make a copy of your driver's license for the file. As the applicant, you hereby allow and release Level2 B ackground Screening Services to perform a Level II Screening or those additional services listed on your application. If your employer or professional regulatory board HAS NOT received your results in 14 days, please call us or send us an at customerservices@level2backgroundscreeing.com immediately so we can check with FDLE about your screening submission. The Applicant holds harmless Level2 Background Screening Services LLC and its affiliates for any errors or omissions in performing these services and for any results of the screening services and understand that we have NO CONTROL over the results and do not receive a copy of the results. APPLICANT NAME: Signature: Form D Updated: 11/8/2016