IDAHO STATE POLICE
BUREAU OF CRIMINAL IDENTIFICATION
NAME BASED CRIMINAL BACKGROUND CHECK FORM
of the Idaho Central Repository of Criminal History Records
A $20 processing fee must be included. Each field must be completed. A separate form must be used for each request. Do not use staples on the
forms. Make checks or money orders payable to the Idaho State Police. A personal check will only be accepted if issued by the requestor or requesting
agency. A $20.00 fee will be charged for any returned checks.
Please print clearly in blue or black ink only. Illegible forms will be returned for clarification.
REQUEST
Please provide an Idaho Criminal History on the individual named below.
Last Name First Name Middle Name
Alias Names (Include Maiden/prior Married Names) Please provide both first and last name.
Date of Birth (mm/dd/yyyy) Social Security Number (optional) Sex Race
Address
City State Zip
WAIVER
Idaho law does not require a waiver. However, without a signed waiver from the subject of the record, any arrest more than 12 months old, without a disposition, cannot be
given to a non-criminal justice agency.
Any waiver other than this waiver will not be accepted.
I hereby give permission for the requester, named below, to receive any information maintained by the Idaho Bureau of Criminal Identification concerning myself.
Signature Date
This signature on the waiver must be within 180 days of the name check
submission.
TO BE COMPLETED BY COMPANY OR PERSON REQUESTING BACKGROUND INFORMATION
Incomplete forms will be returned unproccessed
Requesting Person or Company Address of Requester (Results will be mailed to this address)
Street_____________________________________________________________
City, State & Zip Code ________________________________________________
Printed Name of Requester (Print Legibly) Signature of Requester Phone Number of Requester
General Information:
Idaho law does not require a person to give consent. However, without a signed release from the subject of record, any arrest more than 12 months old, without a
disposition, cannot be given to a non-criminal justice agency.
Results of a Name Based Criminal Background check cannot be notarized.
Criminal history record information furnished as a result of a non-fingerprint based computerized search is based solely on a search of identifiers provided in the request. Be
aware it is not uncommon for criminal offenders to use alias names and false dates of birth, which would adversely affect the completeness and accuracy of a non-fingerprint
based search of the Idaho Central Repository of Criminal History Records. No other state or federal agency records can be searched under current law. The bureau does not
telephone or fax responses. Please allow ample time for processing this request. Requests are processed on a first come basis.
The records maintained by the Idaho Bureau of Criminal Identification (BCI) are based upon the felony and serious misdemeanor arrests reported to BCI from other Idaho
criminal justice agencies. If a person disputes the accuracy of information obtained, that person may challenge the information by writing to the address on this form.
Idaho code 67-3008 (6) states, “A person or private agency or public agency, other than the department, shall not disseminate criminal history record information obtained
from the department to a person or agency that is not a criminal justice agency or court without a signed release of the subject of record unless otherwise provided by law.
700 S. STRATFORD DR. STE. 120 MERIDIAN, ID 83642
(208) 884-7130 FAX (208) 884-7193
Rev. 6/22/2017
Incomplete forms will be returned unproccessed.
