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 Young Women Christian Association 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:
Name of Qualified Entity: Young Women Christian Association
Address: 420 W. Clinch Avenue
City: Knoxville State: TN Zip: 37902
TO BE COMPLETED BY QUALIFIED ENTITY (Not to be filled by applicant):
ORIGINAL MUST BE RETAINED BY QUALIFIED ENTITY
COPY MUST BE SUBMITTED TO TBI
My Signature Indicates that the Previous Information is Complete and Correct to the Best of my Knowledge. I Understand That, If Employed Any Misstatement or Omission of Facts May Result in My Dismissal. It Is Also My Understanding That All Employees Are Subject To A Criminal Background Check.
The YWCA of Knoxville is an Equal Opportunity Employer, and as such, does not discriminate on the grounds of disability, age, race, color, religion, sex, national origin, or any other classification protected by constitutional or statutory law.
As an Applicant for a Position in the YWCA, You May Help Us Monitor Internal Accountability to Our Affirmative Action Program.
*Please Check the Appropriate Space Listed Below:
*Please Note That You Are Not Required to do so as a Part of Your Application and That This Portion is Strictly Voluntary
The YWCA Knoxville is dedicated to eliminating racism, empowering women and promoting peace, juctice, freedom and dignity for all.