U.S. DOD Form dod-da-7215 RELEASE/CONSENT STATEMENT For use of this form see AR 608-18 the proponent agency is OACSIM. 1. TYPED OR PRINTED NAME Last First MI 2. DATE YYYYMMDD 3. SIGNATURE DA FORM 7215 OCT 2003 DA FORM 7215-R AUG 1992 IS OBSOLETE. APD V1. PRIVACY ACT STATEMENT AUTHORITY PRINCIPAL PURPOSE ROUTINE USES DISCLOSURE 42 USC 13041 and 10 USC 3013. To comply with requirements of Public Law 101-647 Section 231 Crime Control Act of 1990. To initiate the background check requirements of the statute. Mandatory. Failure to disclose the information precludes consideration of an application for employment in a child care worker position or may form the basis for removal from a child care worker position if you are a current incumbent of a child care worker position* EMPLOYEE STATEMENT I have been advised that my being hired will be based upon successful completion of a criminal history background check. I understand that the background check includes both a fingerprint check by the FB....