Get OH SHR-Web Check 2011

Franklin County SheriFF S oFFiCe 410 S. High Columbus OH 43215 614-525-5090 Mon. - Fri. 9am - 2pm Type of Background Check needed o BCI State of Ohio only o 30. I certify that the personal identifiers provided on this form are accurate and I voluntarily and knowingly authorize this WebCheck agency 3MU387 Franklin County Sheriffs Office to submit information to the Ohio Bureau of Criminal Identification and Investigation BCI I to conduct a criminal records check for information relating to me. I voluntarily and knowingly authorize BCI I to disseminate criminal arrest conviction and juvenile delinquency adjudication records to the WebCheck provider or agency I have designated to receive this information. liability related to this authorized criminal record review and dissemination. This authorization and waiver is valid for one year from the date this background check was conducted. By signing this form the applicant acknowledges that all information on this form is accurate. Any mistakes or errors on this form are the responsibility of the applicant. Signature Completed by Sheriff s Technician SHR-Web Check Form Rev. 3-2011 Date. 00 CASH ONLY Web Check FBI Nationwide Check only o BFBI Both Ohio Nationwide Checks 60. 00 Please Print Clearly Last Name Date of Birth First Name SSN Address City State Zip Phone Reason for Background Check Mail Background Check Results to Company Name Contact If Any Also Send Results to o Ohio Department of Education ODE o Ohio Board of Nursing Ohio Resident more than 5 years o Yes All Checks are conducted by the Ohio Bureau of Criminal Identification Investigation London Ohio. For the status or question regarding the background check s please contact them at 877 224-0043 or 740 845-2000. I certify that the personal identifiers provided on this form are accurate and I voluntarily and knowingly authorize this WebCheck agency 3MU387 Franklin County Sheriffs Office to submit information to the Ohio Bureau of Criminal Identification and Investigation BCI I to conduct a criminal records check for information relating to me. I voluntarily and knowingly authorize BCI I to disseminate criminal arrest conviction and juvenile delinquency adjudication records to the WebCheck provider or agency I have designated to receive this information* liability related to this authorized criminal record review and dissemination* This authorization and waiver is valid for one year from the date this background check was conducted* By signing this form the applicant acknowledges that all information on this form is accurate. Any mistakes or errors on this form are the responsibility of the applicant. Signature Completed by Sheriff s Technician SHR-Web Check Form Rev* 3-2011 Date. 00 CASH ONLY Web Check FBI Nationwide Check only o BFBI Both Ohio Nationwide Checks 60. 00 Please Print Clearly Last Name Date of Birth First Name SSN Address City State Zip Phone Reason for Background Check Mail Background Check Results to Company Name Contact If Any Also Send Results to o Ohio Department of Education ODE o Ohio Board of Nursing Ohio Resident more than 5 years o Yes All Checks are conducted by the Ohio Bureau of Criminal Identification Investigation London Ohio. For the status or question regarding the background check s please contact them at 877 224-0043 or 740 845-2000. .