AFFIDAVIT FOR RELEASE OF INFORMATION

I hereby authorize the Alabama Law Enforcement Agency to conduct a criminal history background check and to release my criminal history information to the State Superintendent of Education. I do hereby for myself, my heirs, executors, and administrators release and forever discharge the Alabama Law Enforcement Agency and its officers and agents from any and all claims, actions, or causes of action which may arise as a consequence of the release of the criminal history information as authorized herein.

If I am an applicant for certification or licensure, or if I am a certified or licensed applicant for employment in a public school, or an applicant for employment at a nonpublic school, or an applicant for a teacher education program, then I understand that the State Superintendent of Education shall provide a suitability determination based on the State Bureau of Investigation and Federal Bureau of Investigation criminal history background information reports.

If I am applying for employment in a non-certified or non-licensed position in a public school then I understand that my potential employer will be notified of my confirmed convictions and pending charges.

I understand that I may be denied employment, unsupervised access to children, the opportunity to serve, or certification or licensure based upon the information contained in the criminal history background information check.

I understand that a refusal to consent to a criminal history background check will result in me not being hired or, if applicable, me not being certified or licensed.

I am aware that I have the right to obtain a copy of the background check report and to challenge its accuracy and completeness. The procedures for obtaining a change, correction, or updating of an FBI identification record are set forth in Title 28, CFR, § 16.34. I also have a right to obtain a prompt determination as to the validity of such challenge before a decision to retain or hire is made by an employer. Officials making such a determination should not make a decision regarding my license or employment based upon information in the record until I have been afforded a reasonable time to correct or complete the record, or have declined to do so. An individual may Challenge or Appeal any portion of his or her own Alabama Criminal History Record Information (CHRI) maintained by the Alabama Law Enforcement Agency (ALEA) Criminal Records and Identification Unit that he or she believes to be inaccurate. To submit a challenge regarding CHRI provided by the ALEA, Criminal Records and Identification Unit, please call ALEA at (334) 353-4340 or follow the instructions found here.

I understand that I am entitled to due process in accordance with applicable statutes prior to any possible adverse action taken as a result of information reported from a criminal history background check.

Payment of fingerprint fees and submission of fingerprints shall be deemed further positive affirmation of my intent to have a fingerprint based criminal history background check performed as authorized above.

PRIVACY ACT STATEMENT

Authority: The FBI's acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to Pub. L. 92-544, Presidential Executive Orders, and federal regulations. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application.

Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI's Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI.

Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBI's Blanket Routine Uses. Routine uses include, but are not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment, contracting, licensing, security clearances, and other suitability determinations; local, state, tribal, or federal law enforcement agencies; criminal justice agencies; and agencies responsible for national security or public safety.

(Print terms)