Noncriminal Justice Applicant’s Privacy Rights
Print Name: TNumber:
As an applicant who is the subject of a national fingerprint-based criminal history record check for a noncriminal
justice purpose (such as an application for employment or a license, an immigration or naturalization matter, security
clearance, or adoption), you have certain rights which are discussed below.
You must be provided written notification
that your fingerprints will be used to check the criminal history
records of the FBI.
You must be provided, and acknowledge receipt of, an adequate Privacy Act Statement when you submit
your fingerprints and associated personal information. This Privacy Act Statement should explain the
authority for collecting your information and how your information will be used, retained, and shared.
If you have a criminal history record, the officials making a determination of your suitability for the
employment, license, or other benefit must provide you the opportunity to complete or challenge the
accuracy of the information in the record.
The officials must advise you that the procedures for obtaining a change, correction, or update of your
criminal history record are set forth at Title 28, Code of Federal Regulations (CFR), Section 16.34.
If you have a criminal history record, you should be afforded a reasonable amount of time to correct or
complete the record (or decline to do so) before the officials deny you the employment, license, or other
benefit based on information in the criminal history record.
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You have the right to expect that officials receiving the results of the criminal history record check will use it only for
authorized purposes and will not retain or disseminate it in violation of federal statute, regulation or executive order,
or rule, procedure or standard established by the National Crime Prevention and Privacy Compact Council.
If agency policy permits, the officials may provide you with a copy of your FBI criminal history record for review and
possible challenge. If agency policy does not permit it to provide you a copy of the record, you may obtain a copy of
the record by submitting fingerprints and a fee to the FBI. Information regarding this process may be obtained at
https://www.fbi.gov/services/cjis/identity-history-summary-checks.
If you decide to challenge the accuracy or completeness of your FBI criminal history record, you should send your
challenge to the agency that contributed the questioned information to the FBI. Alternatively, you may send your
challenge directly to the FBI. The FBI will then forward your challenge to the agency that contributed the questioned
information and request the agency to verify or correct the challenged entry. Upon receipt of an official
communication from that agency, the FBI will make any necessary changes/corrections to your record in accordance
with the information supplied by that agency. (See 28 CFR 16.30 through 16.34.)
By signing this form, I certify that I have received and read the Noncriminal Justice Applicant’s Privacy Rights noted
above. I also authorize the release of all investigative records to the institution of higher learning (Tennessee Tech
University College for Education) resulting from a fingerprinting sample and a criminal history background check
conducted by the TBI and FBI. I understand that this information may be used by Tennessee Tech University to verify
the accuracy of my application, and may furthermore be grounds for denying admission to the Teacher Education
Program for which I have applied. Additionally, I authorize the institution to use the current qualified Tennessee
licensed private investigation company currently contracted with the state of Tennessee to retain the necessary information
needed. Lastly, I understand that copies of the criminal history records information will not be shared outside of the
College of Education; however, I authorize and understand that a notice of a passing or not passing background
check will be sent to the school system once I begin my clinical placement.
Signature:
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Date:
MAIL TO: Office of Teacher Education, Admission to Teacher Education, TTU Box 5092, Cookeville,TN 38505
OR FAX TO: 931-372-6286 or SUBMIT IN PERSON: TJ Farr, Room 104
