VECHS WAIVER AGREEMENT AND STATEMENT
Volunteer & Employee Criminal History System
for Criminal History Record Checks
under the National Child Protection Act of 1993, as amended
Pursuant to the National Child Protection Act of 1993, as amended, this form must be completed
and signed by every current or prospective employee, volunteer and contractor/vendor, for whom
criminal history records are requested by a qualified entity under these laws.
I hereby authorize (enter Name of Qualified Entity)_____________________________________
to submit a set of fingerprints through the TBI vendor and this form to the Tennessee Bureau of
Investigation (TBI), for the purpose of accessing and reviewing Tennessee and national criminal
history that may pertain to me directly from the FBI, pursuant to 28 CFR, Sections 16.30-16.34. By signing
this Waiver Agreement, it is my intent to authorize the dissemination of any national criminal history
record that may pertain to me to the Qualified Entity with which I am or am seeking to be employed or to
serve as a volunteer, pursuant to the National Child Protection Act of 1993, as amended.
I understand that, until the criminal history background check is completed, you may choose to
deny me unsupervised access to children, the elderly, or individuals with disabilities. I further
understand that, upon request, you will provide me with a copy of the criminal history background
report, if any, you receive on me
and that I am entitled to challenge the accuracy and completeness of
any information contained in any such report. I may obtain a prompt determination as to the validity of
my challenge before you make a final decision about my status as an employee, volunteer, contractor,
or subcontractor.
A national criminal history background check on me is being requested by the following:
I have OR have not been convicted of a crime.
If convicted, desc
ribe the crime(s) and the particulars of the conviction(s) in the space below:
BI-xxxx
RDA
Name of Qualified Entity:
Address:
City:
State:
Zip:
TN Tech University, College of Education
TN Tech University, College of Education
