CRIMINAL BACKGROUND CHECK INSTRUCTIONS - …

1 STATE OF ARKANSAS Ruthie Bain SOCIAL WORK LICENSING BOARD Executive Director Phone 501-372-5071. Mailing Address Street Address Fax 501-372-6301. Asa Hutchinson P. O. Box 251965 2020 West Third, Suite 518 Email: Governor Little Rock, AR 72225 Little Rock, AR 72205 Website: CRIMINAL BACKGROUND CHECK INSTRUCTIONS . Dear Applicant: AR Code Annotated 17-103-307 requires all applicants for social work licensure to apply to the Identification Bureau of the Arkansas State Police for state and national CRIMINAL BACKGROUND checks prior to being issued licensure.

2 A valid application for licensure must be on file prior to BACKGROUND checks being processed. No Applicant will be issued licensure (includes provisional) until the results of the CRIMINAL BACKGROUND CHECK are received. It may take 2 - 6 weeks to receive the results. It is the responsibility of the applicant to submit the following forms to the Board: 1. Completed Record CHECK Form (must be notarized). 2. Completed fingerprint card ( INSTRUCTIONS below). 3. Required processing fee. Money Order or Cashier's CHECK payable to INFORMATION. NETWORK OF ARKANSAS.

3 No personal checks or cash will be accepted. INSTRUCTIONS : 1. Complete the Record CHECK Form and have it notarized. 2. Obtain a completed fingerprint card. You MUST use a standard FBI fingerprint card used for noncriminal fingerprinting. You can obtain this card at your local police department, sheriff's office, state police office, or you can contact the Arkansas Social Work Licensing Board to have one sent to you. We can accept cards with other information printed in the ORI. field. We will correct it. 3. Attach a Money Order or Cashier's CHECK payable to INFORMATION NETWORK OF.

4 ARKANSAS (No personal checks or cash accepted) See amount due on Record CHECK Form 4. Mail all forms to: Social Work Licensing Board Box 251965. Little Rock, Arkansas 72225. If you have questions or need additional information, please contact the board office at the above address or phone number. 04/2015. Applicant Notification and Record Challenge Applicants who are the subject of a national fingerprint-based CRIMINAL history record CHECK for a noncriminal justice purpose, have certain rights which are discussed below. Applicants must be provided written notification that the applicant's fingerprints will be used to CHECK the CRIMINAL history records of the FBI.

5 The notification must be kept for the lifetime of the CRIMINAL history record information. They are allowed a reasonable opportunity to challenge the accuracy of the CRIMINAL history record information. (ALL applicants must be advised of this, not just those who dispute an employment/license denial or who feel their CHRI is incorrect). If the applicant elects to challenge the CRIMINAL history record information, the agency must provide the applicant a reasonable period of time to do so before final denial. The agency should also establish and document what constitutes a reasonable period of time for the review and challenge and any appeals process that is available to the applicant.

6 For a copy of an Arkansas CRIMINAL history record: The individual can contact Arkansas Crime Information Center (ACIC) at (501) 682-7444 or Arkansas State Police at (501) 618-8000. For a copy of an FBI CRIMINAL history record: Department of Justice Order rules allow the subject of an FBI record to request a copy of his/her own record. The individual may submit fingerprints, an Applicant Information Form, and payment directly to the FBI according to the procedures in Title 28 Code of Federal Regulations . FBI website for information about record review and challenge: checks/challenge-of-an-identity-historys ummary ASP and FBI CBC INSTRUCTIONS March 2015.

7 RECORD CHECK FORM Please make sure this is The most recent form on file Before submitting. Information AR920150Z Is subject to change. SOCIAL WORK. LICENSING BOARD. You must have a current application on file before the BACKGROUND CHECK can be processed. BACKGROUND checks conducted under Arkansas Code Ann. ACA 17-103-307. ITEMS NEEDED: 1. This form completed (typed or printed clearly). 2. One completed fingerprint card 3. One money order or cashier's CHECK (no personal checks), made payable to Information Network of Arkansas in the amount of $ Full Name:_____/_____.

8 First Middle Last Maiden/Other Date of Birth: _____ Race: _____ Sex: _____ Ethnicity:_____ Place of Birth:_____. (Month/Day/Year) (City and State). Social Security #: _____-_____-_____ Driver's License #: _____Issuing State:_____. Mailing Address: _____. Street City State Zip Code I , THE UNDERSIGNED, GIVE MY CONSENT FOR THE ARKANSAS STATE POLICE TO. CONDUCT A STATE AND FEDERAL BUREAU OF INVESTIGATION (FBI) CRIMINAL . RECORD CHECK ON MYSELF AND RELEASE ANY RESULTS TO THE SOCIAL WORK. LICENSING BOARD. I attest I have read the applicant Notification and Record Challenge.

9 Signature: _____ Date: _____. (First/MI/Last Name). (NO REQUEST WILL BE PROCESSED WITHOUT A NOTARIZED SIGNATURE.). STATE OF _____. COUNTY OF _____. Subscribed and sworn before me, a Notary Public in and for the county and state aforesaid, this the _____ day of _____, 20_____. _____ (SEAL). Notary Public RETURN THIS FORM, FEE, AND FINGERPRINT CARD TO: SOCIAL W0RK LICENSING BOARD. BOX 251965. LITTLE ROCK, AR 72225. 04/15/2015. FBI Fingerprint Card INSTRUCTIONS : You MUST use a standard FBI fingerprint card used for noncriminal fingerprinting. You can obtain this card at your local police department, sheriff's office, state police office, or you can contact the Arkansas Social Work Licensing Board office to have one sent to you.

10 Have fingerprints done by someone APPROPRIATELY TRAINED to collect them. A delay in the processing of your FBI CRIMINAL BACKGROUND CHECK is commonly caused by incomplete FBI fingerprint cards and poor quality of fingerprints. o Your local police or sheriff's department may be willing to accommodate you. There may or may not be a fee involved. The Arkansas State Police ID Bureau in Little Rock, on Geyer Springs Road at I-30, will do your fingerprints WITHOUT charge Monday through Friday from 8:30 to 4:30 DO NOT BEND OR FOLD THE FBI FINGERPRINT CARD place in an appropriately sized mailing envelope with the Record CHECK Form and required fee.