Delta LSP Background Check

Processed by
Request for Louisiana Statewide Criminal History Search
Facility requesting criminal history records for employment/education purposes pursuant to LA R.S. 40:1203.1 and LA R.S. 40:1203.2 a criminal history information search which has been approved by the Louisiana Bureau of Criminal Identification and Information within the Department of Public Safety and Corrections, Office of the State police.
Select the campus in which you are enrolling:*

MonroeMonroe - State Office BuildingWest MonroeTallulahDelhiLake ProvidenceRayvilleBastropRustonFarmervilleWinnsboro
Name*

First NameMiddle NameLast Name
Include Maiden name and/or previous married name(s) if applicable
Separate multiple names by a comma
Email*
example@example.com
Phone Number*

Area CodePhone Number
Social Security Number*
XXX-XX-XXXX
Date of Birth*

MonthDayYear
Gender

MaleFemale
Race*
Driver's License Number
Drivers License State
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
A NATIONAL SEX OFFENDER REGISTRY SEARCH WILL BE CONDUCTED

AS REQUIRED BY LOUISIANA STATE LAW
Authorization to Disclose Criminal History Record Information

I understand that a thorough investigation will be conducted from the files that are maintained with the Louisiana Department of Public Safety and Corrections, Office of State Police.
By signing and submitting this background request I understand and agree to the following:
- The $45 fee for the background check is nonrefundable regardless of if I choose to not attend the class or I am not accepted into the class.
- Fingerprints may be required by the Louisiana State Police prior to the final background check results being provided.
- Fingerprints submitted to the Louisiana State Police by mail will take up to 21 business days from the date received for the final results to be returned.
- Expedited fingerprinting can be conducted by traveling in person to the Louisiana State Police Office in Baton Rouge, Louisiana to have your fingerprints electronically scanned.
- If fingerprints are needed instructions for obtaining and submitting submission to the Louisiana State Police will be provided by your school representative.
- All background check results will be returned to the school in which the application is processed for.
By my signature below, I authorize such an investigation and release of all criminal record information, which may confirm or deny my eligibility for employment/enrollment with the facility named above. I waive such legal rights and release all persons from any liabilities in connection with furnishing such information to the above facility. I understand that it is a crime to provide false information concerning a criminal history check to an employer.

My Products*

Louisiana Statewide Criminal History Search$45.00

Total $0.00

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Student Signature:
Signature*

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Request for Louisiana Statewide Criminal History Search

A NATIONAL SEX OFFENDER REGISTRY SEARCH WILL BE CONDUCTED

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