(CONTINUED ON PAGE 4)
-3-
CRIMINAL
HISTORY
RECORD CHECK
FEDERAL
BUREAU OF
INVESTIGATION
("FBI") REPORT
All applicants are required to submit to a FBI fingerprint check through the Hawaii Criminal Justice Data
Center (HCJDC). To obtain a FBI national Criminal History Record check and the State of Hawaii
Criminal History Record check, applicants shall be fingerprinted electronically at Fieldprint Inc.
locations nationwide or any other fingerprinting agency approved to send electronic fingerprints to
the Hawaii Criminal Justice Data Center ("HCJDC").
Please visit Fieldprint Inc. at: http://fieldprinthawaii.com to make an appointment, inquire about
other available site locations on the Continental United States, or call (877) 614-4361.
Fees for the FBI and the State of Hawaii Criminal History Record checks shall be paid directly to
Fieldprint and will be electronically sent to the HCJDC.
NOTE: A license application must be filed within 30 days of the fingerprinting to ensure that the
results are obtainable from the HCJDC. If the results are not obtainable, you will be required to obtain
new fingerprints.
Applicant Notification and Record Challenge: Your fingerprints will be used to check the criminal
history records of the FBI. Your fingerprints will also be retained by the HCJDC and the FBI for all
purposes and uses authorized for fingerprint submissions, which may include participation in the state
and national rap back programs. You have the opportunity to complete or challenge the accuracy of
the information contained in the FBI identification record. The procedure for obtaining a change,
correction, or updating an FBI identification record are set forth in Title 28, CFR, 16.34.
DOCUMENTATION
REQUIREMENTS
FOR "YES"
ANSWERS TO
QUESTIONS (3), (4)
OR (5)
The following documentation/materials must be submitted with the license application or submitted
directly from the official source. Applications will not be processed without this documentation/
materials.
If you answered "YES" to question #3, "Have you ever been convicted of a crime in any jurisdiction
that has not been annulled or expunged?", you must submit the following:
1.
a) A detailed statement signed by you explaining the underlying circumstances that led to the
conviction(s);
Certified copies of court documents related to the conviction that include but is not limited to
the indictment(s), judgments, disposition of the court, terms of sentence and sanctions. Also,
if applicable, proof of compliance with any sanctions imposed by the court(s) i.e. proof of
payment of fines, completion of course, etc; and
If you are currently on parole or probation, a certified copy of the terms of the parole or
probation and a statement from your parole or probation officer as to your compliance with
the court orders.
b)
c)
2. If you answered "YES" to question #4, "Has any license ever been revoked, suspended, or otherwise
subject to disciplinary action by the Hawaii State Board or another state board?", you must submit
the following:
a)
b)
a)
A detailed statement signed by you explaining the underlying circumstances that led to the
disciplinary action(s); and
Certified copies of any documents from the agency (other Board of Nursing) including final
orders, petitions, complaints, findings of fact and conclusions of law, consent orders, and any
other relevant documents.
A detailed statement signed by you explaining the underlying circumstances that led to the
disciplinary action(s); and
3. If you answered "YES" to question #5, "Are you presently being investigated or is any disciplinary
action pending against you?", you must submit the following:
b) Certified copies of any documents from the agency (other Board of Nursing) including
petitions, complaints, findings of fact and conclusions of law, consent orders, and any other
relevant documents.
