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APPLICANT PROCESSING - DISCLOSURE FORM RIGHT TO REVIEW (Baton Rouge Community College)

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NAME
ADDRESS
CITY STATE
ZIP CODE
DATE OF BIRTH
PLACE OF BIRTH RACE WEIGHT
(STATE)
HEIGHT HAIR COLOR EYE COLOR
SOCIAL SECURITY NUMBER
RIGHT TO REVIEW
DO NOT WRITE BELOW THIS LINE: {For Bureau of Criminal Identification and Information Use Only}
CRIMINAL HISTORY DETERMINATION:
RAPSHEET ATTACHED
NOTICE: The response to your request for a criminal history check is based on a review of the State of
Louisiana's criminal history records database as is available at the time of request. This does not preclude
the possible existence of conviction information not available in our database.
RESPONSE BELOW
APPLICANT PROCESSING - DISCLOSURE FORM
Louisiana Bureau of Criminal Identification and Information
P.O. BOX 66614 (Box A-6)
BATON ROUGE, LA 70896
Revised 1/8/2018
SEX
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APPLICANT PROCESSING - DISCLOSURE FORM RIGHT TO REVIEW (Baton Rouge Community College)

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Completed 17 September 2020

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