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Get AR ASP-122 2019-2024

When an Arkansas background check is requested include a properly completed ASP 122 request form and a check or money order in the amount of 25. When the properly completed ASP 122 form is submitted other than in person at the ASP ID Bureau in Little Rock by the subject of the record check this request form must be notarized. 5. 34 and/or Arkansas Code 12-12-1013. 3. If the request is made by mail an envelope properly addressed to the person/entity to whom the background check will be released as specified on the ASP 122 form with sufficient return postage must be included. 4. ARKANSAS STATE POLICE ASP 122 Rev. 02/19/2019 Identification Bureau Individual Record Check Request Form INSTRUCTIONS If you are mandated by law to have the background check performed please contact the licensing agency/entity that requires the background check for the proper request form. 1. 00 DO NOT SEND CASH made payable to the Arkansas State Police. A fingerprint card is NOT required to be submitted if only the Arkansas background check is requested* The results of the Arkansas background check will be sent to the person/entity as specified on this form* 2. The subject of the criminal records search may challenge the completeness or accuracy of the criminal history information by using the procedures as outlined in Title 28 Code of Federal Regulation CFR Section 16. Send properly completed request form envelope and proper payment to Arkansas State Police 1 State Police Plaza Drive Little Rock AR 72209 To contact the Arkansas State Police ID Bureau you may call 501-618-8500. SEE OTHER SIDE FOR REQUEST FORM Front Last Name First Name Month/Day/Year State of Birth Social Security Jr. /Sr. /III Daytime Phone List ALL other names ever used married maiden shortened etc* Middle Name Race Sex Driver s License Mailing Address State Street/P. O. Box City Zip Code APPLICANT RECORD NOTICE Obtaining Copy Procedures for obtaining a copy of the FBI criminal history record are set forth in Title 28 Code of Federal Regulations CFR Section 16. 30 through 16. 33 or the FBI website at http //www. fbi. gov/about-us/cjis/backgroundchecks. Change Correction or Updating Procedures for obtaining a change correction or updating of an FBI criminal history record are set forth in Title 28 Code of Federal Regulations CFR Section 16. 34. I give my consent for the Arkansas State Police to conduct a criminal record search on myself and release any results to the following person or entity Signature Date First/MI/Last Name Release to WHEN THIS PROPERLY COMPLETED REQUEST FORM IS SUBMITTED OTHER THAN IN PERSON BY THE SUBJECT OF THE CHECK THIS REQUEST FORM MUST BE NOTARIZED STATE OF COUNTY OF Subscribed and sworn before me a Notary Public in and for the county and state aforesaid this is the day of. 00 DO NOT SEND CASH made payable to the Arkansas State Police. A fingerprint card is NOT required to be submitted if only the Arkansas background check is requested* The results of the Arkansas background check will be sent to the person/entity as specified on this form* 2. The subject of the criminal records search may challenge the completeness or accuracy of the criminal history information by using the procedures as outlined in Title 28 Code of Federal Regulation CFR Section 16. .

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