Fillable Early Childhood Education Criminal History Record Check (Indian Hills Community College)

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Early Childhood Education Criminal History Record Check (Indian Hills Community College)

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DCI-77 (updated 06-26-2018)
Page 1 of 2
DCI Account Number: ______________________
(if applicable)
Mail or Fax completed forms to: Send results to:
Iowa Division of Criminal Investi
g
ation Name
Support Operations Bureau, 1
st
Floor
215 E. 7
th
Street Address
Des Moines, Iowa 50319
(515) 725-6066
(515) 725-6080 Fax
Phone
Fax
I am requesting an Iowa Criminal History Record Check on:
Last Name
(mandatory)
First Name
(mandatory)
Middle Name
(recommended)
Date of Birth
(mandatory)
Gender
(
mandatory
)
Social Security Number
(
recommended
)
Male
Female
Release Authorization:
Without a signed release from the subject of the request, a complete criminal history record may
not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law,
always obtain a signed release from the subject of the request.
***This form (DCI-77) is the only approved release authorization form for this purpose.***
Release Authorization:
I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of
Criminal Investigation (DCI). Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. I understand this can include
information concerning completed deferred judgments and arrests without dispositions.
Release Authorization Signature
: ___________________________________________________________________________
STATE OF IOWA
Criminal History Record Check
Request Form
Iowa Criminal History Record Check Results
(DCI use only)
As of ___________________, a search of the provided name and date of birth revealed:

No Iowa Criminal History Record found with DCI

Iowa Criminal History Record attached, DCI #______________
DCI initials
______________
click to sign
signature
click to edit
DCI-77 (updated 06-26-2018)
Page 2 of 2
Release Authorization Information:
Iowa law does not require a release authorization. However, without a signed release authorization
from the subject of the request any arrest over 18 months old, without a final disposition, cannot be
released to a non-law enforcement agency.
Deferred judgments where DCI has received notice of successful completion of probation also cannot
be released to non-law enforcement agencies without a signed release authorization from the subject of
the request.
If the “No Iowa Criminal History Record found with DCI” box is checked, it could mean that the
information on file is not releasable per Iowa law without a signed release authorization.
General Information:
The information requested is based on name and exact date of birth only. Without fingerprints, a
positive identification cannot be assured. If a person disputes the accuracy of information maintained
by the Department, they may challenge the information by writing to the address on the front of this
form or personally appearing at DCI headquarters during normal business hours.
The records maintained by the Iowa Department of Public Safety are based upon reports from other
criminal justice agencies and therefore, the Department cannot guarantee the completeness of the
information provided.
The criminal history record check is of the Iowa Central Repository (DCI) only. The DCI files do not
include other states’ records, FBI records, or subjects convicted in federal court within Iowa.
In Iowa, a deferred judgment is not generally considered a conviction once the defendant has been
discharged after successfully completing probation. However, it should be noted that a deferred
judgment may still be considered as an offense when considering charges for certain specified multiple
offense crimes, i.e. second offense OWI. If a disposition reflects that a deferred judgment was given,
you may want to inquire of the individual his or her current status.
A deferred sentence is a conviction. The judge simply withholds implementing a sentence for a certain
probationary period. If probation is successful, the sentence is not carried out.
Any questions in reference to Iowa criminal history records can be answered by writing to the address
on the front of this form or calling (515) 725-6066 between 8:00 a.m. and 4:00 p.m., Monday - Friday.
REMINDER - (1) Send in a separate Request Form for each last name, (2) a fee is required for each
last name submitted, (3) a completed Billing Form must be submitted with all request(s).
Iowa law requires employers to pay the fee for potential employees’ record checks.
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Early Childhood Education Criminal History Record Check (Indian Hills Community College)

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Completed 19 July 2020

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