"Authorization to Release Copy of Fbi Background Check Report" - New Mexico

Authorization to Release Copy of Fbi Background Check Report is a legal document that was released by the New Mexico Public Education Department - a government authority operating within New Mexico.

Form Details:

  • Released on October 5, 2009;
  • The latest edition currently provided by the New Mexico Public Education Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the New Mexico Public Education Department.

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S T A T E O F N E W M E X I C O
PUBLIC EDUCATION DEPARTMENT
LICENSURE BACKGROUNDS UNIT
300 Don Gaspar
Santa Fe, New Mexico 87501-2786
www.ped.state.nm.us
A
R
C
FBI B
C
R
UTHORIZATION TO
ELEASE
OPY OF
ACKGROUND
HECK
EPORT
Please type or print clearly; incomplete forms will not be processed.
Date _______________
Name: _______________________________________ Gemalto-Cogent Registration#____________________________
Must be for reason “TEACHER LICENSURE” to be valid for PED
PED License #
_________________ SS#
_______________________
(if known):
(full)
I hereby authorize NM PED Backgrounds to release a copy of my results for the following reason:
NM School Employment in a:
Licensed Position
Non-Licensed Position
Student Teaching/Classroom Observation
University Educational Program
NM DVR Program
 
Other Reasons:_____________________________________
Information to be sent via
Mail
E-mail
Fax
(check one):
Please make sure below instructions are clear and legible.
__________________________________________
Name
__________________________________________
Mailing Address
__________________________________________
City, state, zip
Email: ______________________________ Fax #: ___________________________________
X_____________________________________________________________________________
Applicant’s Written Signature
(Copy will NOT be released without a signature) No E-signatures accepted.
Return Completed Form by
Mail: NM Public Education Department, Licensure Background Check Unit, 300 Don Gaspar, Santa Fe, NM 87501
Fax: 505-827-1449 or scan & emailed to:
stephaniej.lujan@state.nm.us
A copy of an FBI Criminal History Report will not be released to an individual without a valid, legible,
NOTE.
EFFECTIVE OCTOBER 5, 2009:
photo ID that bears the requestor’s signature.
The photo ID must be one of the following: valid US state vehicle operator’s license, valid passport, valid US military ID.
If requesting by mail, include on a separate page a legible copy of the individual’s photo ID.
ID copy is not required if the copy is being sent to an NM school district.
Background check report will not be released to an out of state agency.
S T A T E O F N E W M E X I C O
PUBLIC EDUCATION DEPARTMENT
LICENSURE BACKGROUNDS UNIT
300 Don Gaspar
Santa Fe, New Mexico 87501-2786
www.ped.state.nm.us
A
R
C
FBI B
C
R
UTHORIZATION TO
ELEASE
OPY OF
ACKGROUND
HECK
EPORT
Please type or print clearly; incomplete forms will not be processed.
Date _______________
Name: _______________________________________ Gemalto-Cogent Registration#____________________________
Must be for reason “TEACHER LICENSURE” to be valid for PED
PED License #
_________________ SS#
_______________________
(if known):
(full)
I hereby authorize NM PED Backgrounds to release a copy of my results for the following reason:
NM School Employment in a:
Licensed Position
Non-Licensed Position
Student Teaching/Classroom Observation
University Educational Program
NM DVR Program
 
Other Reasons:_____________________________________
Information to be sent via
Mail
E-mail
Fax
(check one):
Please make sure below instructions are clear and legible.
__________________________________________
Name
__________________________________________
Mailing Address
__________________________________________
City, state, zip
Email: ______________________________ Fax #: ___________________________________
X_____________________________________________________________________________
Applicant’s Written Signature
(Copy will NOT be released without a signature) No E-signatures accepted.
Return Completed Form by
Mail: NM Public Education Department, Licensure Background Check Unit, 300 Don Gaspar, Santa Fe, NM 87501
Fax: 505-827-1449 or scan & emailed to:
stephaniej.lujan@state.nm.us
A copy of an FBI Criminal History Report will not be released to an individual without a valid, legible,
NOTE.
EFFECTIVE OCTOBER 5, 2009:
photo ID that bears the requestor’s signature.
The photo ID must be one of the following: valid US state vehicle operator’s license, valid passport, valid US military ID.
If requesting by mail, include on a separate page a legible copy of the individual’s photo ID.
ID copy is not required if the copy is being sent to an NM school district.
Background check report will not be released to an out of state agency.