"Notice Pursuant to the National Child Protection Act of 1993 as Amended by the Volunteers for Children Act" - Nevada

Notice Pursuant to the National Child Protection Act of 1993 as Amended by the Volunteers for Children Act is a legal document that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada.

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NOTICE PURSUANT TO THE NATIONAL CHILD PROTECTION ACT OF 1993 AS
AMENDED BY THE VOLUNTEERS FOR CHILDREN ACT
Applicant:
The National Child Protection Act of 1993 (NCPA), Public Law (Pub. L.) 103-209, as amended by the
Volunteers for Children Act (VCA), Pub. L. 105-251 (Sections 221 and 222 of Crime Identification
Technology Act of 1998), codified at 42 United States Code (U.S.C.) Sections 5119a and 5119c,
authorizes a state and national criminal history background check to determine the fitness of an employee,
or volunteer, or a person with unsupervised access to children, the elderly, or individuals with disabilities.
Pursuant to the VCA, the entity (a) to which you have applied for employment or to serve as a volunteer;
(b) by which you are employed or serve as a volunteer; or (c) which provides care to someone to whom
you have or may have unsupervised access, may request a background check. Your rights and
responsibilities under the VCA are as follows:
1. Provide a set of fingerprints.
2. Provide your name, address, and date of birth, as appears on a document made or issued by or
under the authority of the United States Government, a State, political subdivision of a State, a
foreign government, a political subdivision of a foreign government, an international
governmental or an international quasi-governmental organization which, when completed with
information concerning a particular individual, is a type or commonly accepted for the purpose of
identification of individuals 18 U.S.C. §1028(d)(2).
3. Provide a certification that you (a) have not been convicted of a crime, (b) are not under
indictment for a crime, or (c) has been convicted of a crime. If you are under indictment or have
been convicted of a crime, you must describe the crime and the particulars of the conviction, if
any.
4. You are entitled to (a) obtain a copy of any background check report and (b) challenge the
accuracy and completeness of any information contained in any such report and obtain a prompt
determination as to the validity of such challenge before a final determination is made by entity
performing the background check. Such request for a copy of your criminal history record and any
challenge to the accuracy of such record should be addressed to the entity or the Nevada
Department of Public Safety.
5. Prior to the completion of the background check, the entity may choose to deny you
unsupervised access to a person to whom the entity provides care.
Revised: 10/31/13
NCPA/VCA Notice
1
NOTICE PURSUANT TO THE NATIONAL CHILD PROTECTION ACT OF 1993 AS
AMENDED BY THE VOLUNTEERS FOR CHILDREN ACT
Applicant:
The National Child Protection Act of 1993 (NCPA), Public Law (Pub. L.) 103-209, as amended by the
Volunteers for Children Act (VCA), Pub. L. 105-251 (Sections 221 and 222 of Crime Identification
Technology Act of 1998), codified at 42 United States Code (U.S.C.) Sections 5119a and 5119c,
authorizes a state and national criminal history background check to determine the fitness of an employee,
or volunteer, or a person with unsupervised access to children, the elderly, or individuals with disabilities.
Pursuant to the VCA, the entity (a) to which you have applied for employment or to serve as a volunteer;
(b) by which you are employed or serve as a volunteer; or (c) which provides care to someone to whom
you have or may have unsupervised access, may request a background check. Your rights and
responsibilities under the VCA are as follows:
1. Provide a set of fingerprints.
2. Provide your name, address, and date of birth, as appears on a document made or issued by or
under the authority of the United States Government, a State, political subdivision of a State, a
foreign government, a political subdivision of a foreign government, an international
governmental or an international quasi-governmental organization which, when completed with
information concerning a particular individual, is a type or commonly accepted for the purpose of
identification of individuals 18 U.S.C. §1028(d)(2).
3. Provide a certification that you (a) have not been convicted of a crime, (b) are not under
indictment for a crime, or (c) has been convicted of a crime. If you are under indictment or have
been convicted of a crime, you must describe the crime and the particulars of the conviction, if
any.
4. You are entitled to (a) obtain a copy of any background check report and (b) challenge the
accuracy and completeness of any information contained in any such report and obtain a prompt
determination as to the validity of such challenge before a final determination is made by entity
performing the background check. Such request for a copy of your criminal history record and any
challenge to the accuracy of such record should be addressed to the entity or the Nevada
Department of Public Safety.
5. Prior to the completion of the background check, the entity may choose to deny you
unsupervised access to a person to whom the entity provides care.
Revised: 10/31/13
NCPA/VCA Notice
1
THE FOLLOWING MUST BE COMPLETED BY APPLICANT
Applicant’s Name: _____________________________________________________________________
(PLEASE PRINT LAST, FIRST, MIDDLE)
Date of Birth: _________________________________________________________________________
Address on identification document: _______________________________________________________
□ I have been convicted of, or am under pending indictment for the following crimes. You must
include the dates, locations/jurisdictions, circumstances and outcome.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
□ I have not been convicted of nor am I under pending indictment for any crimes.
Applicant’s Signature: __________________________________________________________________
Date: ________________________________________________________________________________
THE FOLLOWING MUST BE COMPLETED BY AUTHORIZED RECIPIENT
Identification document referenced for verification:
___________________________________________
TYPE (passport, driver’s license, ID card, etc.)
___________________________________________
COUNTRY/STATE
_____#______________________________________
DOCUMENT NUMBER
___________________________________________
AUTHORIZED RECIPIENT SIGNATURE
___________________________________________
DATE
Revised: 10/31/13
NCPA/VCA Notice
2
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