This form is a provided as a courtesy for the use of employers. Other versions are allowed to meet Title 63 O.S. § 1-1947(H), which requires that an applicant shall provide the employer a government photo identification of the applicant and written consent for the employer to conduct a registry screening and the [Okla. State Bureau of Investigation (OSBI)] to conduct a state and national criminal history record check under this section. The employer shall maintain the written consent and information regarding the individual’s identification in their files for audit purposes. It is recommended a copy of the identification be maintained with the applicant's written consent.
EMPLOYER MUST RETAIN THIS SIGNED APPLICANT CONSENT.
Instructions to Applicant: [63 O.S. 1-1945 et. seq.] Evidence of an applicant's consent to a check of state and/or
national licensure, certification, abuse, exclusion and offender registries, and fingerprinting for a state and national criminal history records check is required. If you have an active employment history in OK-SCREEN, new fingerprints may not be needed. New registry checks must be done. With your consent, the employer will submit your information through the OK-SCREEN web portal for checks against state and national registries. If you are cleared, and the employer wishes to continue, you will get an email or telephone notice to schedule an
appointment for fingerprinting, if required. You will be responsible for a Ten Dollar ($10) processing fee at the
time the appointment is scheduled unless the employer elects to pay the fee. You will have ten (10) calendar days
to submit your fingerprints or you will be required to start over [63 O.S. § 1-1947(I4)].
Declarations: By signing this form I consent to registry screening and submission of my fingerprints to the OSBI
for forwarding to the Federal Bureau of Investigation for the purpose of conducting a state and national criminal history records check pursuant to 63 O.S. § 1-1947(H I understand that the results will be shared with the Oklahoma National Background Check Program (ONBCP) operated by the Oklahoma State Department of Health (OSDH). I understand that if my criminal history results reveal information that prevents the Department from making a final determination, I will be given notice and will have sixty (60) days to make corrections or additions. If I am unable to make corrections or additions within the sixty (60) days, the Department will either deny me eligibility based on the disqualifying results or advise me they cannot make a determination and notify me of my right to appeal. The notice shall include the reasons I was found not eligible for employment and a statement that I have a right to appeal. [63 O.S. § 1-1947(K)]
I understand that as a condition of employment, I agree to report to the employer immediately upon being
arraigned, indicted, convicted, or pleading guilty or nolo contendere to one or more of the criminal offenses
applicable to my license, certification, permit or employment class; or upon being the subject of a substantiated
finding on a registry as described in this Consent and Release and Title 63, Section 1-1947. I understand an arraignment may also be cause for employment restrictions or termination. [63 O.S. § 1-1947(Q)]
Authority: The FBI’s acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to Pub. L. 92-544, Presidential Executive Orders, and federal. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application.
Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI’s Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI.
Oklahoma National Background Check Program - http://ONBC.health.ok.gov