Form IG/BSU-001 "Request for Background Screening for DJJ State Employment & Volunteers" - Florida

What Is Form IG/BSU-001?

This is a legal form that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the Florida Department of Juvenile Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form IG/BSU-001 by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

ADVERTISEMENT
ADVERTISEMENT

Download Form IG/BSU-001 "Request for Background Screening for DJJ State Employment & Volunteers" - Florida

Download PDF

Fill PDF online

Rate (4.4 / 5) 29 votes
IG/BSU-001
Revised 05/2019
CONFIDENTIAL
DEPARTMENT OF JUVENILE JUSTICE - OFFICE OF THE INSPECTOR GENERAL
BACKGROUND SCREENING UNIT
REQUEST FOR BACKGROUND SCREENING
DJJ STATE EMPLOYMENT & VOLUNTEERS
FOR
Detention
Residential
Probation
Prevention
Administration
Other______________________
Check this box if the applicant is or was
a Florida law enforcement officer or certified officer with the Department of Corrections
A. TO BE COMPLETED BY APPLICANT/VOLUNTEER/INTERN
Last Name
First Name
Full Middle Name
Maiden/Alias
Position Applied for
Caretaker
Special Trust
Not Special Trust
Driver’s License #:
Social Security #:
Race/Sex:
DOB:
B. TO BE COMPLETED BY REQUESTOR
Requestor’s Name (Contact Person)
Telephone Number & Ext. #
Fax Telephone Number
Office/Facility/Program Name and Mail Address
E-mail Address
I hereby authorize the Department of Juvenile Justice (DJJ) to check any records pertaining to my criminal history, driver’s license history, and juvenile criminal history pursuant to
Sections 39.001 and Chapters 435, 984, and 985, Florida Statutes. I further authorize any law enforcement agency to release to DJJ information regarding convictions and
dispositions under Florida Statutes or statutes of other jurisdictions. I understand that as a criminal justice agency, DJJ has access to all criminal records, even those that have been
sealed or expunged. This consent applies to any and all future screenings conducted by DJJ. I understand that my fingerprints will be submitted for a criminal-record check to the
Florida Department of Law Enforcement (FDLE) and the Federal Bureau of Investigations (FBI) and that once submitted, my fingerprints will be retained by FDLE while I am
employed at DJJ and if arrested, the arrest will be reported directly to DJJ by FDLE.
Applicant’s Signature
People First ID
Date
C. FOR BSU PERSONNEL USE ONLY
Note: The applicant’s fingerprints are submitted to the Florida and National Crime Information Centers (FCIC/NCIC). Criminal history reports are the result
of fingerprint analysis conducted by the Florida Department of Law Enforcement and Federal Bureau of Investigations.
Eligible
Ineligible/Not Eligible
Identified/Non-Caretaker Only
(Applicant has a disqualifying offense. Exemption is needed to
(Applicant has a disqualifying offense but will not work
work or serve in a position of special trust or responsibility.)
in a position of special trust or responsibility.)
Apply for EXEMPTION
Applicant CAN
Applicant CANNOT
*The Criminal History Record provided is exempt from chapter 119 and should not be disclosed or disseminated
Criminal Record*:
Yes
No
TCN#:
(Attached)
Judicial Inquiry System:
Yes (
No
Attached)
Hot File:
Yes
No
(Attached)
*warrant- protection order-probation
Hot File –Identified Risk:
Yes
No
(Attached)
*Violent Felony Offender-Career or
Habitual Offender- Sexual Offender-
Sexual Predator
Subject of DJJ Reportable Incident:
Yes
No
(Attached)
Automated Training Management
System:
Yes
No
N/A
(Attached)
COMMENTS:
Signature of Screener:
Date:
Signature of Reviewer:
Date:
Clear Form
Save As..
Print
IG/BSU-001
Revised 05/2019
CONFIDENTIAL
DEPARTMENT OF JUVENILE JUSTICE - OFFICE OF THE INSPECTOR GENERAL
BACKGROUND SCREENING UNIT
REQUEST FOR BACKGROUND SCREENING
DJJ STATE EMPLOYMENT & VOLUNTEERS
FOR
Detention
Residential
Probation
Prevention
Administration
Other______________________
Check this box if the applicant is or was
a Florida law enforcement officer or certified officer with the Department of Corrections
A. TO BE COMPLETED BY APPLICANT/VOLUNTEER/INTERN
Last Name
First Name
Full Middle Name
Maiden/Alias
Position Applied for
Caretaker
Special Trust
Not Special Trust
Driver’s License #:
Social Security #:
Race/Sex:
DOB:
B. TO BE COMPLETED BY REQUESTOR
Requestor’s Name (Contact Person)
Telephone Number & Ext. #
Fax Telephone Number
Office/Facility/Program Name and Mail Address
E-mail Address
I hereby authorize the Department of Juvenile Justice (DJJ) to check any records pertaining to my criminal history, driver’s license history, and juvenile criminal history pursuant to
Sections 39.001 and Chapters 435, 984, and 985, Florida Statutes. I further authorize any law enforcement agency to release to DJJ information regarding convictions and
dispositions under Florida Statutes or statutes of other jurisdictions. I understand that as a criminal justice agency, DJJ has access to all criminal records, even those that have been
sealed or expunged. This consent applies to any and all future screenings conducted by DJJ. I understand that my fingerprints will be submitted for a criminal-record check to the
Florida Department of Law Enforcement (FDLE) and the Federal Bureau of Investigations (FBI) and that once submitted, my fingerprints will be retained by FDLE while I am
employed at DJJ and if arrested, the arrest will be reported directly to DJJ by FDLE.
Applicant’s Signature
People First ID
Date
C. FOR BSU PERSONNEL USE ONLY
Note: The applicant’s fingerprints are submitted to the Florida and National Crime Information Centers (FCIC/NCIC). Criminal history reports are the result
of fingerprint analysis conducted by the Florida Department of Law Enforcement and Federal Bureau of Investigations.
Eligible
Ineligible/Not Eligible
Identified/Non-Caretaker Only
(Applicant has a disqualifying offense. Exemption is needed to
(Applicant has a disqualifying offense but will not work
work or serve in a position of special trust or responsibility.)
in a position of special trust or responsibility.)
Apply for EXEMPTION
Applicant CAN
Applicant CANNOT
*The Criminal History Record provided is exempt from chapter 119 and should not be disclosed or disseminated
Criminal Record*:
Yes
No
TCN#:
(Attached)
Judicial Inquiry System:
Yes (
No
Attached)
Hot File:
Yes
No
(Attached)
*warrant- protection order-probation
Hot File –Identified Risk:
Yes
No
(Attached)
*Violent Felony Offender-Career or
Habitual Offender- Sexual Offender-
Sexual Predator
Subject of DJJ Reportable Incident:
Yes
No
(Attached)
Automated Training Management
System:
Yes
No
N/A
(Attached)
COMMENTS:
Signature of Screener:
Date:
Signature of Reviewer:
Date:
Clear Form
Save As..
Print