Ospra 104 Form PDF Details

Are you in the process of starting a business? If so, it is important to know that filling out and correctly submitting your Ospra 104 form is an essential first step in beginning your new venture. While this form may seem complicated at first glance, it doesn't have to be intimidating. In this post, we will walk through all of the necessary steps and information associated with completing the Form Ospra 104 accurately and efficiently. We will take a look at what information you need to fill out on the form as well as offer helpful guidance for ensuring smooth processing when filing it with your local government office. Let's get started!

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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Completing segment 1 in mail 104 form

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