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Get NY OSPRA 102 2003-2024

I further understand that once the history notifications from DCJS to my new employer Signature Mail or fax completed OSPRA 102 to OSPRA 987 EBA fax 518 473-8812. OSPRA 102 1/03 Clearance For Employment Request Form Type or Print All Information 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 This form is to be filed to secure a Clearance for Employment for an individual who has been previously fingerprinted on New York State Education Department SED fingerprint cards or the New York City Department of Education NYCDOE fingerprint cards. Sections 1 and 3 are to be completed by the prospective employee. The school district charter school or BOCES must complete section 2. Instructions Type or print all information* Inaccurate incomplete or illegible information will delay processing* SECTION 1 Name Last First Middle Initial Social Security Number Mailing Address Date of Birth 00/00/0000 City State Zip This section MUST be completed by the school district charter school or BOCES OSPRA Processing Dates Please neatly print type or attach a label in the box below with the name and mailing address of the fingerprint contact person of the school district charter school or BOCES* This form will be returned to the person identified below if SED has no fingerprint application on file for the above individual as of the OSPRA Processing Dates. Make no other marks in the box below or the box to the right of this space. leave blank First 6 digits of school BEDS or CS-ID Charter Schools Please contact OSPRA to obtain your specific CS-ID number Title of position employee will be placed in Signature of employer representative or fingerprint contact person Date Telephone of fingerprint contact person I have read Fingerprinting Information and Instructions issued by the State Education Department and SED have previously submitted fingerprints to SED pursuant to the SAVE legislation* 2. I understand that if I have any questions about my rights I may contact the OSPRA office at 518 473-2998. I hereby authorize the Commissioner of Education to review my criminal history record as secured from DCJS and the FBI for the purposes of conducting a determination on a Clearance for Employment as a condition for my new employment. I understand that the Commissioner will forward such final determination to my prospective employer in accordance with Part 87 of the Commissioner s Regulations. highered*nysed*gov/tcert/ospra OSPRA mail*nysed*gov This form is to be filed to secure a Clearance for Employment for an individual who has been previously fingerprinted on New York State Education Department SED fingerprint cards or the New York City Department of Education NYCDOE fingerprint cards. Sections 1 and 3 are to be completed by the prospective employee. The school district charter school or BOCES must complete section 2. .

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