Fingerprint Referral Form – Fill Out and Use This PDF

Updated: Nov 11, 2026

The Fingerprint Referral Form is a document used by the New York City Department of Education to initiate a background check on individuals applying for positions within the organization. This form requires accurate completion of personal and background information and involves multiple sections that must be filled out by both the referring official and the applicant. To ensure a smooth process, please complete the form by clicking the button below.

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Fingerprint Referral Form PDF Details

The Fingerprint Referral Form, utilized by the New York City Department of Education Division of Human Resources & Talent, represents a crucial step in the hiring and vetting process for potential employees. With a structure aimed at collating comprehensive personal information, the form is meticulously divided into sections, overseen by various offices within the department. The first section requires completion by an authorizing official and collects certification details about the referring individual. The subsequent part, filled out by the applicant, features probing questions that delve into the applicant's background, probing for any legal infractions or situations that might affect their eligibility for employment. The final segment shores up the process by ensuring employment eligibility, tying in with the broader due diligence efforts of the Office of Personnel Investigation. This intricate setup underscores the department's commitment to safeguarding its educational environment, ensuring only qualified and vetted individuals make their way through. Central to this initiative is the transparency and truthfulness expected from applicants, especially in disclosing criminal records, which, if not accurately reported, could result in application denial, underscoring the critical balance between privacy rights and the need for security within educational institutions.

Question	Answer
Form Name	Fingerprint Referral Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	65 court street fingerprinting, doe fingerprinting, doe fingerprint referral form, nycdoe applicant gateway

How to Fill Out Form 551

Form 551 at a glance

What it is: Fingerprint Referral Form, Form 551, of the New York City Department of Education Division of Human Resources & Talent.

Who signs: Please sign your name at the end of this section. Signature of person being fingerprinted, Today's Date.

Section II (Background Questions) must be completed by the applicant.

A filled-in Form 551 example: an applicant fills Section II

Form 551 example filled out, example: an applicant fills Section II — Jane Ann Sample, a job applicant, fills Section II of the referral form. She has no other name, so Other or Maiden Name stays empty; she marks Female and White. The picture shows part of page 1; none of its entries is real. She has no file number, so File Number stays empty.

How to fill out Form 551, box by box

Your name, other or maiden name, date of birth and sex

Enter your LAST NAME, FIRST NAME and M.I.

Enter the OTHER OR MAIDEN NAME and the DATE OF BIRTH as Month, Day and Year. PLEASE (√) ONE: Male or Female.

Check the box which best describes you

Check the box which best describes you: 1. American Indian/Alaskan Natives, 2. Asian: includes Asian Indians, Chinese, Japanese, Koreans, Filipinos, Indonesians, and Polynesians, 3. Black (Not of Hispanic Origin), 4. Hispanic, 5. White (Not of Hispanic Origin).

Address, telephone number, file number and e-mail address

Enter the STREET ADDRESS, APT. NUMBER, CITY, STATE and ZIP CODE.

Enter the (AREA) TELEPHONE NUMBER, the FILE NUMBER (IF ANY) and the E-MAIL ADDRESS.

More rules for Form 551

Section I (Certification Referring Official) must be completed by the appropriate office. Section III (Employment Eligibility Verification) will be completed by the Office of Personnel Investigation.

Please print all information clearly on the form.

Answer “YES” or “NO” to the following questions. You must answer these questions truthfully even though you may have disclosed the same information to the Department of Education or another agency on a previous occasion.

1. Have you ever been convicted of or pled "GUILTY" or pled "NO CONTEST" to any offense in this state or elsewhere? This includes Felonies, Misdemeanors and Violations. For Felonies or Misdemeanors, you must answer "Yes" if you were convicted or pled guilty or no contest even if your records have been sealed.

Please be advised that if you answer “NO” to question #1 and your fingerprint results disclose a conviction record, your application will be denied.

2. Are any criminal charges currently pending against you anywhere?

3. Have you ever been placed on a state registry as a sex offender in New York State or elsewhere?

4. Have you ever forfeited bail or bond following your appearance as a defendant in a criminal court action?

5. Has a warrant been issued by a court requiring that you appear in court?

6a. Has a Family Court ever found that you abused or neglected a child? If so, explain which court issued the finding, the nature of the finding, and when it happened.

6b. Are you currently in arrears [4 months or more] for child support payments?

7. Have you ever been discharged [fired] or required to resign from any position for reasons other than a layoff due to reduction in the work force?

8. Have you ever been denied employment as a result of information obtained following a background check or investigation? If so, explain the reasons for denial of employment.

9. Have you ever resigned or left a job rather than face charges or dismissal?

10a. Has an employer ever brought or filed charges against you?

10b. If yes, were you found guilty of the charges?

11. Have you ever had any professional certificate or license denied, revoked or suspended?

12. Have you ever applied for a civil service position, such as police officer or worker for a federal, state, city or local agency, and been notified you do not qualify?

13. Have you ever had a teaching license or certificate denied, revoked or suspended by any Education Department: New York City, New York State or elsewhere?

14. Have you ever received an unsatisfactory rating or unsatisfactory evaluation for your work in a school?

15. Have you ever lost your job as a teacher, or as another pedagogue, before achieving tenure?

16. Did you ever receive a discharge from military service for reasons other than an honorable discharge?

17a. Are you now, or were you ever employed by the NYC Department of Education? If yes, indicate dates ________________________.

17b. Were you ever fingerprinted by the NYC Department of Education?

If your answer to any of these questions is “YES”, explain, giving details, in the space provided.

Common questions about Form 551

Who signs it?

Please sign your name at the end of this section. Signature of person being fingerprinted, Today's Date.

Is there a penalty?

Falsifying an employment application is a punishable offense under the Penal Law of New York State.

Sources

[1] Form 551, Fingerprint Referral Form, New York City Department of Education Division of Human Resources & Talent (the Official source link on this page).