Fillable Name Based Criminal Background Check Form printable pdf download

IDAHO STATE POLICE

BUREAU OF CRIMINAL IDENTIFICATION

NAME BASED CRIMINAL BACKGROUND CHECK FORM

of the Idaho Central Repository of Criminal History Records

A $20 processing fee must be included.

Each field marked with an asterisk (*) must be completed. A separate form must be used for each

request. Do not use staples on the forms. Make checks or money orders payable to the Idaho State Police. Personal check will only be accepted if issued by

the requestor or requesting agency. A $20.00 fee will be charged for any returned checks.

Please print clearly in blue or black ink only.

REQUEST

Please provide an Idaho Criminal History on the individual named below.

*Last Name

*First Name

Middle Name

Alias Names (Include Maiden/prior

*Date of Birth (mm/dd/yy)

Sex

Race

Social Security Number (optional)

Married Names)

Address

City

State

Zip

WAIVER

Idaho law does not require a waiver. However, without a signed waiver from the subject of the record, any arrest more than 12 months old, without a disposition, cannot be

given to a non-criminal justice agency. Any waiver other than this waiver will not be accepted.

I hereby give permission for the requester, named below, to receive any information maintained by the Idaho Bureau of Criminal Identification concerning myself.

Signature

Date

This signature on the waiver must be within 180 days of the name check submission.

MUST BE COMPLETED BY PERSON OR COMPANY REQUESTING BACKGROUND INFORMATION

*Requesting Person or Company

*Address of Requester (Results will be mailed to this address)

Street______________________________________________

City, State & Zip Code ________________________________

*Printed Name of Requester (Print Legibly)

*Signature of Requester

*Phone Number of Requester

Results of Non-Certified Record Search

Record Attached

No Record Found

BCI Initials

Date

General Information:

Idaho law does not require a person to give consent. However, without a signed release from the subject of record, any arrest more than 12 months old, without a

Results of a Name Based Criminal Background Check cannot be notarized.

disposition, cannot be given to a non-criminal justice agency.

Criminal history record information furnished as a result of a non-fingerprint based computerized search is based solely on a search of identifiers provided in the request. Be

aware it is not uncommon for criminal offenders to use alias names and false dates of birth, which would adversely affect the completeness and accuracy of a non-fingerprint

based search of the Idaho Central Repository of Criminal History Records. No other state or federal agency records can be searched under current law. The bureau does not

telephone or fax responses. Please allow ample time for processing this request. Requests are processed on a first come basis.

The records maintained by the Idaho Bureau of Criminal Identification (BCI) are based upon the felony and serious misdemeanor arrests reported to BCI from other Idaho

criminal justice agencies. If a person disputes the accuracy of information obtained, that person may challenge the information by writing to the address on this form.

Idaho code 67-3008 (6) states, “A person or private agency or public agency, other than the department, shall not disseminate criminal history record information obtained

from the department to a person or agency that is not a criminal justice agency or court without a signed release of the subject of record unless otherwise provided by law.

700 S. STRATFORD DR. STE. 120  MERIDIAN, ID 83642

(208) 884-7130  FAX (208) 884-7193

Revised 08/07/2013

Name Based Criminal Background Check Form

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