Bcia 8374 Form PDF Details

In the State of California, the BCIA 8374 form serves as a vital document for individuals applying to be recognized as a Custodian of Records according to Penal Code section 11102.2. This comprehensive form, updated in July 2019 by the Department of Justice, covers a broad range of information, starting from basic applicant details to more in-depth questions regarding past legal and professional experiences. Applicants are required to provide personal information, including names, contact information, and pertinent identification numbers, as well as detailed answers to questions concerning past arrests, convictions, professional license histories, and liabilities in suits for damages. The form is designed to ensure that persons applying for or currently holding positions that give them access to sensitive information are of the highest integrity and reliability. Furthermore, it delineates the conditions under which personal information collected may be used and shared, emphasizing the importance of security and confidentiality in handling Criminal Offender Record Information (CORI). As a critical step in the application process, the BCIA 8374 form underscores both the responsibility of managing such records and the stringent measures in place to prevent misuse. Applicants are reminded that any misrepresentation or failure to disclose requested information can lead to denial or revocation of their confirmation as Custodian of Records, accentuating the form’s significance in maintaining the integrity of criminal records management within the state.

QuestionAnswer
Form NameBcia 8374 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namescustodian record application, custodian confirmation, bcia application, bcia 8374 form

Form Preview Example

STATE OF CALIFORNIA BCIA 8374

(Rev. 07/2019)

DEPARTMENT OF JUSTICE

PAGE 1 of 2

CUSTODIAN OF RECORDS APPLICATION FOR CONFIRMATION

(Penal Code section 11102.2)

Last Name:

Address:

Applicant Information

First Name:

Middle Name:

 

 

 

City:

 

State:

 

Zip Code:

 

 

 

 

 

 

 

 

 

Phone Number:

Date of Birth:

Driver's License/CA ID Number:

Email:

Agency/Organization Information

Agency Head:

Phone Number:

Agency Name:

Address:

 

ORI:

Mail Code:

 

 

 

 

 

City:

State:

Zip Code:

 

 

 

 

Please answer fully the following questions:

1.

Does the designated Custodian of Records work for the applicant agency?

 

 

Yes

 

No

 

If yes, what is the relationship?

 

 

 

 

 

 

 

 

 

If no, what is the relationship?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

Have you ever used a name other than the one on this application?

 

Yes

 

 

No

 

If yes, please list other names below:

 

 

 

 

3.Have you ever been arrested in California or any other state and/or are you awaiting adjudication for any offense for which you were arrested? Yes No If yes, give details below:

4.Have you ever been convicted by any court of a felony or misdemeanor offense in California or any other state? Yes No

If yes, disclose the date and place of arrest, whether the conviction was for a felony or misdemeanor, and the sentence imposed:

5. Have you ever been denied a professional license or had such license revoked, suspended, or restricted?

 

Yes

 

No If yes, give details below:

6.Have you ever been adjudged liable for damages in any suit grounded in fraud, misrepresentation, or in violation of state regulatory

laws?

 

Yes

 

No If yes, give details below:

 

 

 

 

 

 

 

 

 

7. Have you ever failed to satisfy any court ordered money judgment including restitution?

 

Yes

 

No If yes, give details below:

Misrepresentation or Failure to Disclose Requested Information on this Application

Is Cause for Denial or Revocation of Confirmation.

Certification

I certify under penalty of perjury under the laws of the State of California to the truth and accuracy of all statements, answers, and representations made in the foregoing application, including all supplementary statements.

Signature of Applicant

 

 

Date

 

 

 

 

 

California Department of Justice

 

DOJ USE ONLY

 

 

 

 

Bureau of Criminal Information and Analysis

 

Confirmation of Custodian of Records

Custodian of Records Unit

 

 

 

 

P.O. Box 903417

Date confirmed:

 

Completed by:

 

Sacramento, CA 94203-4170

 

 

 

(initials)

 

 

 

 

 

STATE OF CALIFORNIA

DEPARTMENT OF JUSTICE

BCIA 8374

PAGE 2 of 2

(Rev. 07/2019)

 

CUSTODIAN OF RECORDS

APPLICATION FOR CONFIRMATION

(Penal Code section 11102.2)

Privacy Notice

As Required by Civil Code § 1798.17

Collection and Use of Personal Information. The California Justice Information Services (CJIS) Division in the Department of Justice collects the information requested on this form as authorized by Penal Code section 11102.2(d). The CJIS Division uses this information for the purpose of processing fingerprint-based criminal offender record information background responses on individuals designated by applicant agencies to serve as Custodian of Records. In addition, any personal information collected by state agencies is subject to the limitations in the Information Practices Act and state policy. The Department of Justice's general privacy policy is available at: http://oag.ca.gov/privacy-policy.

Providing Personal Information. All the personal information requested in the form must be provided.

Access to Your Information. You may review the records maintained by the CJIS Division in the Department of Justice that contain your personal information, as permitted by the Information Practices Act. See below for contact information.

Possible Disclosure of Personal Information. In order to process fingerprint-based criminal offender record information background responses on individuals designated by applicant agencies to serve as Custodian of Records, we may need to share the information you give us with other law enforcement or regulatory agencies.

The information you provide may also be disclosed in the following circumstances:

•With other persons or agencies where necessary to perform their legal duties, and their use of your information is compatible and complies with state law, such as for investigations or for licensing, certification, or regulatory purposes;

•To another government agency as required by state or federal law.

Contact Information. For questions about this notice or access to your records, you may contact the Custodian of Records Program Analyst by phone at (916) 210-5468, by e-mail at COR@doj.ca.gov, or via mail at:

California Department of Justice

Bureau of Criminal Information and Analysis

Custodian of Records Unit

P.O. Box 903417

Sacramento, CA 94203-4170

CALIFORNIA DEPARTMENT OF JUSTICE

CALIFORNIA JUSTICE INFORMATION SERVICES DIVISION

CRIMINAL OFFENDER RECORD INFORMATION SECURITY REQUIREMENTS

Use of Applicant Criminal Offender Record Information

Custodian of Records must sign and return document

CUSTODIAN OF RECORDS DUTIES

1.The information provided by the Department of Justice (DOJ) to this agency is confidential and shall not be disseminated to any other person or agency not authorized by law. A violation of this section is a misdemeanor (Penal Code section 11142). However, the requesting agency may provide a copy of the DOJ applicant response to the subject of the record.

2.All personnel/individuals with access to Criminal Offender Record Information (CORI) will have a fingerprint background clearance record check completed through the DOJ as required by the California Code of Regulations section 703(d) prior to the submission of fingerprints for employment, licensing, certification, or volunteer purposes.

3.All personnel/individuals with access to CORI will have a signed "Employee Statement Form" on file acknowledging an understanding of laws prohibiting its misuse.

4.All personnel/individuals with access to CORI will be trained in the secure handling, storage, dissemination, and destruction of CORI.

5.My agency/organization will have a written policy for securing access, storage, dissemination, and destruction of criminal record information. This policy will include the steps to be taken to prevent unauthorized access to CORI maintained in our agency files.

6.The DOJ may conduct audits of the authorized persons or agencies using CORI to ensure compliance with state laws and regulations (California Code of Regulations section 702(c)).

7.The information provided by the DOJ will be maintained in a secured area/locked cabinet separate from the employees personnel file and be used only for the purpose for which it was acquired.

8.Our agency/organization will notify the DOJ with regard to any change of agency name, address, telephone number, fax number, Custodian of Records, and contact person.

9.The "NLI Notification Form" will be sent to the DOJ when applicable.

10.Our agency/organization will send an updated "Live Scan Subscriber Agreement Form" to the DOJ signed by our new agency official when applicable.

On behalf of our agency/organization, I hereby acknowledge that I have read and agree to the above.

Signature:

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

Print Name:

 

 

 

 

Title:

 

 

 

Contributing Agency/Organization Name:

 

 

 

 

 

 

 

 

 

 

Mailing Address:

 

 

 

 

 

 

 

 

 

 

City:

State:

 

 

Zip Code:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Physical Address:

 

 

 

 

 

 

 

 

 

 

City:

State:

 

 

Zip Code:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How to Edit Bcia 8374 Form Online for Free

custodian record application can be completed online in no time. Simply try FormsPal PDF tool to perform the job promptly. In order to make our editor better and simpler to use, we constantly work on new features, considering suggestions from our users. With some basic steps, you are able to begin your PDF journey:

Step 1: First of all, access the tool by clicking the "Get Form Button" above on this site.

Step 2: When you open the file editor, you'll see the document all set to be completed. Besides filling out different fields, you could also do several other actions with the PDF, namely writing your own text, editing the original textual content, inserting images, placing your signature to the PDF, and much more.

For you to complete this PDF form, be certain to enter the right information in every blank field:

1. Whenever filling in the custodian record application, be certain to incorporate all of the needed blanks in its associated section. It will help hasten the work, making it possible for your information to be processed swiftly and accurately.

bcia 8374 form conclusion process detailed (part 1)

2. When this section is complete, you have to add the essential specifics in Have you ever been convicted by, Yes, If yes disclose the date and place, Have you ever been denied a, Yes, If yes give details below No, Have you ever been adjudged, laws If yes give details below, Yes, Have you ever failed to satisfy, Yes, If yes give details below, Misrepresentation or Failure to, Is Cause for Denial or Revocation, and Certification allowing you to move forward to the third stage.

laws If yes give details below, Misrepresentation or Failure to, and Yes of bcia 8374 form

Many people frequently make some errors when filling in laws If yes give details below in this part. Ensure that you read twice what you type in here.

3. In this part, have a look at Signature of Applicant, California Department of Justice, Bureau of Criminal Information and, Date, DOJ USE ONLY, Confirmation of Custodian of, Custodian of Records Unit, PO Box , Sacramento CA , Date confirmed, Completed by, and initials. Every one of these should be filled in with greatest accuracy.

Confirmation of Custodian of, Completed by, and PO Box inside bcia 8374 form

4. This fourth section comes with these particular blanks to look at: On behalf of our, Signature, Print Name, Contributing AgencyOrganization, Date, Title, Mailing Address, City, Physical Address, City, State, State, Zip Code, and Zip Code.

Zip Code, On behalf of our, and State of bcia 8374 form

Step 3: After rereading your entries, hit "Done" and you're all set! Obtain your custodian record application when you join for a 7-day free trial. Immediately use the pdf inside your personal account page, together with any edits and changes conveniently kept! We don't share or sell any details that you use when dealing with documents at FormsPal.

Bcia 8374 Form isn’t the one you’re looking for?

Related Documents