SOP_NUMBER: 104.12-att-2
TITLE: Applicant Privacy Rights Notification Signature Form
REFERENCE_CODE: IVO03-0006
DIVISION: Administrative & Finance
TOPIC_AREA: 104 Policy-HR Applicant/Vacancy/Hiring/Position
EFFECTIVE_DATE: 2024-12-11
WORD_COUNT: 126
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/968942
URL: https://gps.press/sop-data/104.12-att-2/

SUMMARY:
This form notifies job applicants of their privacy rights regarding fingerprint-based criminal history background checks conducted through the FBI. It informs applicants that they have the right to review, challenge, and request corrections to their FBI criminal history records under federal regulations. The form must be signed by the applicant and retained in personnel records for three years.

KEY_TOPICS: applicant privacy rights, fingerprinting, FBI criminal history records, background check, record challenge, applicant notification, hiring procedures, CFR 16.34, identity history summary, employment application

ATTACHMENTS:
  1. Applicant Privacy Rights
     URL: https://gps.press/sop-data/104.12-att-1/
  2. Applicant Privacy Rights Notification Signature Form
     URL: https://gps.press/sop-data/104.12-att-2/

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FULL TEXT:
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SOP 104.12
Attachment 2

12/11/2024

**Applicant Privacy Rights**
**Notification Signature Form**

**Applicant Notification and Record Challenge:**

Your fingerprints will be used to check the criminal history records of the FBI. You have the
opportunity to complete or challenge the accuracy of the information contained in the FBI
identification record. The procedure of obtaining a change, correction or updating an FBI
identification record is set forth in Title 28, Code of Federal Regulations (CFR), 16.34.

Procedures for obtaining a copy of the FBI criminal history record are set forth in 28 CFR 16.30
through 16.33 or review the FBI website (https://www.fbi.gov/services/cjis/identity-historysummary-checks).


Signature Date


Print Name Employee ID
(if current state employee)


Record Retention: Retain in the CHRM and the local personnel office for a period of three (3)
full years.