Ospra 104 Form PDF Details

In an effort to streamline processes within educational employment and certification, the OSPRA 104 form serves as a crucial conduit for those seeking to transition their career within the education sector in New York. This form essentially bridges information gaps between the City School District of New York and the New York State Education Department by allowing the transfer of a candidate's criminal history record, a step that is vitally important for both initial certification and continued employment within the state's educational institutions. Specifically designed for individuals who have previously been fingerprinted by the New York City Board of Education after July 1, 1990, it plays a pivotal role in ensuring that candidates meet the stringent requirements set forth for educational personnel. The detailed sections within the form guide applicants through providing personal details, specifying the nature of their application—whether they are leaving, joining, or continuing within the NYCBOE—and authorizing the release of their criminal history records. Importantly, this form not only facilitates background checks but also aids in maintaining the safety and integrity of educational environments, assuring that those who stand at the forefront of children's education are appropriately vetted. With clear instructions for completion and mailing, the OSPRA 104 form underscores the importance of accuracy and completeness in processing applications without delays, thereby serving as a testament to the commitment to quality and safety in New York's educational system.

QuestionAnswer
Form NameOspra 104 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesospra 104, mail 104 form, nycboe clearance state get, ospra 104 pdf

Form Preview Example

OSPRA 104 (10/07)

Authorization to Forward Criminal History

Record Information from the City School District of the City of New York to the New York State Education Department

Type or Print All Information

Office of School Personnel Review and

Accountability

NYS Education Department

ph: (518) 473-2998

www.highered.nysed.gov/tcert/ospra

OSPRA@mail.nysed.gov

Instructions to Applicant: Please complete Sections 1, 2 and 3 and mail the form to the address in Section 4.

Please Note: This form is to be filed by individuals who have been previously fingerprinted (after July 1, 1990) for a license and/or employment by the New York City Board of Education (NYCBOE) and are authorizing the NYCBOE to forward their criminal history to the New York State Education Department for certification application and/or employment purposes.

SECTION 1

(Inaccurate or incomplete information will delay processing)

Name: (Last)

(First)

(Middle)

Sex: (M/F)

Home Address: (Street, Apt. #)

Social Security Number

City, State, Zip:

Telephone (Area Code and Number)

E-mail Address:

Date of Birth (Month, Day, Year)

SECTION 2

Please choose ( ) one of the following:

I am leaving or have left the employ of the NYCBOE and am seeking clearance for certification and/or employment.

I am remaining in the employ of the NYCBOE and I am seeking clearance for certification.

I am remaining in the employ of the NYCBOE and I am seeking additional employment in a covered school other than the NYCBOE.

SECTION 3

•I hereby authorize the NYCBOE to forward the content of my criminal history record as secured from DCJS and the FBI to the New York State Education Department as a condition of my application for certification and/or clearance for employment. I further understand that the NYCBOE is authorized to forward subsequent criminal history notifications received from DCJS to the New York State Education Department.

•I understand that if my fingerprints have not been retained by DCJS, I will have to be fingerprinted again to meet the requirements of Chapter 180 of the Laws of 2000.

•I understand that if I am seeking clearance for employment, an OSPRA 102 will have to be filed by my prospective employer before a clearance will be issued.

Signature:

Date:

SECTION 4

MAIL TO:

Division of Human Resources

HR Connect Walk-in Center

65 Court Street, Room 102

Brooklyn, New York 11201

Ph: (718) 935-4000 Fax: (718) 935-2726

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