Ospra 101 Form PDF Details

When navigating the process of seeking employment or certification within New York State’s educational system, the OSPRA 101 form represents a crucial step. This consent form, pivotal for the fingerprinting and criminal history records search, is overseen by the Office of School Personnel Review and Accountability (OSPRA) under the NYS Education Department. It meticulously outlines the procedure for prospective employees and applicants eyeing teacher or administrator certifications, ensuring the integrity and safety within schools. Applicants are required to complete and submit sections 1, 2, and 5, with assistance from their prospective employer for sections 3 and 4 if aiming for clearance for employment. The necessity to fully complete the fingerprint cards, accompanied by the mandated fee—$94.25 as of the latest update—without the option to use personal checks, underscores the process's thoroughness. Furthermore, the form conveys rights and responsibilities regarding the review, challenge, and confidentiality of one’s criminal history, highlighting the balanced approach of ensuring educational environment safety while respecting individual rights. The explicit mention of the handling of fingerprint information and the potential for fee waivers adds layers of consideration for applicants, typifying the depth and comprehensive nature of the OSPRA 101 form's role in the educational system’s hiring and certification processes.

QuestionAnswer
Form NameOspra 101 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform ospra 101 printable, ospra 101, ospra101, form ospra fingerprinting

Form Preview Example

OSPRA 101 (06/03)

Consent Form For Fingerprinting And

Criminal History Records Search of

Prospective Employees And Applicants

For Certification

Office of School Personnel Review

and Accountability

NYS Education Department

987 Education Building Annex

Albany, NY 12234

ph: (518) 473-2998

fax: (518) 473-8812

www.highered.nysed.gov/tcert/ospra

OSPRA@mail.nysed.gov

For Fiscal Use Only

Leave Blank

Instructions to

Applicant:

Please completely fill out sections 1, 2 and 5 on this form prior to submission.

If you are seeking clearance for employment, have the prospective employer complete sections 3 and 4. Fill out the top portion of the fingerprint cards completely in accordance with the sample fingerprint card. Get a bank check, certified check, money order or employer check for $94.25 (effective 10/23/07) payable to the New York State Education Department. No personal checks accepted.

Take the completed OSPRA 101, the completed fingerprint cards and the $94.25 fee to the fingerprint location to get fingerprinted. Get fingerprinted. Sign the fingerprint card.

Mail the completed OSPRA 101, the completed fingerprint cards and the $94.25 fee to OSPRA in the preaddressed stamped envelope.

Type or print all information. Inaccurate, incomplete or illegible information will delay processing.

SECTION 1

Social Security Number:

Name (Last, First, Middle Initial):

Mailing Address:

City:

State:

Zip:

Telephone number & area code:

Date of Birth (00/00/0000):

State or Country of Birth:

Height:

Weight:

Sex:

Race:

Hair:

Eyes:

SECTION 2

Please choose (9) one of the following (or both, if applicable):

I am or will be applying for Teacher or Administrator Certification

I am applying for Clearance for Employment

SECTION 3

(This section MUST be completed by the prospective employer if you are seeking clearance for employment)

 

 

 

School District/ BOCES/Charter School

Charter Schools: Please contact OSPRA

 

 

 

Contract Service Provider

 

 

 

 

 

if you do not know your BEDS #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prospective Employer Name:

 

First six digits of school BEDS #:

 

 

Federal Tax ID number:

 

 

 

 

 

 

 

 

 

 

 

 

Employer Address:

Title of Position of Prospective Employee:

 

Fingerprinting Contact Person:

Contact Phone #:

Identify who is paying the $99 (effective 7/1/03) fingerprinting fee:

 

 

 

 

 

 

Prospective Employee

 

School/Employer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Employer Representative or Fingerprinting Contact Person:

SECTION 4

(This section MUST be completed by the Contract Service Provider "CSP" if the prospective employer is a CSP)

Name of primary district in which the prospective employee will work; this district will receive the clearance for employment, not the CSP (a 102 must be completed for each additional district):

First six digits of BEDS code of Primary District

SECTION 5

1.I have read "Fingerprinting Information and Instructions" (OSPRA 100) issued by the State Education Department and understand that the Commissioner of Education is required by law and regulation to request a fingerprint-supported criminal history record from the Division of Criminal Justice Services (DCJS) and the Federal Bureau of Investigation (FBI). The Commissioner is authorized to review such information for the purposes of issuing a clearance for employment or the certificate for which I have applied.

2.I have been informed of the procedures and my right to obtain, review, and challenge the accuracy and completeness, where appropriate, of my criminal history information pursuant to regulations and procedures established by DCJS and the FBI.

3.I understand that I have the right to withdraw my application for employment, without prejudice, any time before employment is offered or declined, regardless of whether a prospective employer or I have reviewed my criminal history information.

4.I understand that I may submit to the Commissioner any information that may be relevant to the consideration of my application including, where applicable, information in regard to good conduct and rehabilitation.

5.I have been advised that the criminal history record forwarded to the Commissioner by DCJS and the FBI shall be confidential pursuant to the applicable federal and state laws, rules and regulations and shall not be published or in any way disclosed to persons other than the Commissioner unless otherwise authorized by law. I understand, however, that certain information regarding subsequent arrest notifications received by the Commissioner shall be forwarded to my employing school district, charter school, or board of cooperative educational services.

6.I understand that the fee for DCJS and the FBI to conduct a fingerprint supported criminal history background check is established at $94.25. I can apply for a "fee waiver" from my prospective employer if such fee would cause an unreasonable financial hardship. In order for the Commissioner to process my application, my prospective employer or I must enclose the $94.25 fee by certified check, money order, or school check payable to the New York State Education Department.

7.I have been informed of my right to request that my fingerprints be destroyed when I am no longer employed at a school district, charter school or board of cooperative educational services. I also understand that in the event my employment is terminated and I have not become employed in the same or another school district, charter school or board of cooperative educational services within twelve months of such termination, the Commissioner shall notify DCJS of such termination and the record of my fingerprints for the purpose of employment shall be destroyed.

8.I understand that no clearance for employment will be issued unless my prospective employer has completed Section 3.

9.If I am an applicant for certification, I understand that receipt of my certificate is the only documentation that I will receive indicating that my fingerprints have been cleared, unless I am also seeking clearance for employment and have had my prospective employer complete Section 3.

I have read this consent form and hereby authorize and consent for the Commissioner of Education to use my fingerprints to secure my criminal history record from DCJS and the FBI. I declare and affirm that the fingerprints submitted are my own, and that the information I entered on the fingerprint cards and this consent form is true, complete and accurate. I do authorize NYSED to obtain and review criminal records, including arrests, and dispositions as part of their background investigation of my suitability for employment.

Applicant Signature:

Date:

SECTION 6

Name and Address of

Agency Where Fingerprint

Services Performed:

SECTION 7

Mail completed packet to:

(consent form, fingerprint cards and a certified check, money order, or school check for $94.25 payable to the New York State Education Department)

Fingerprint Processing

NYS Education Department

PO Box 7352

Albany, NY 12214-0349

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