Fingerprint Handler Sheet -Teacher Standards And Practices Commission (Page 2 of 3) in pdf

Fingerprint Handler Sheet -Teacher Standards And Practices Commission Page 2

Applicant Name:

SSN:

Teacher Standards and Practices Commission

250 Division St. NE

Salem, OR 97301

Fax: (503) 378-3758

Voice: (503) 378-3586

Fingerprint Handler Sheet

This form must be completed by an authorized fingerprinting agent.

The person presenting you with this form will be using it to apply to be an Oregon student

teacher, educator, or school nurse. In order to ensure proper verification of handling of this card

by the applicant and to avoid an incomplete or improper application, please answer the following

questions. Please then sign this form and enclose it along with the completed fingerprint cards

in an envelope.

1._____ Has the applicant filled out the personal information on the fingerprint card to include:

name (including aliases), complete mailing address, social security number, citizenship, date of

birth, and personal information (sex, race, etc.)?

2._____ Have you made a positive identification of this applicant using at least one form of

picture identification, such as a photo driver's license, Division of Motor Vehicles photo

identification card, military identification card, student body card, etc.?

3._____ Does the applicant have one fingerprint card and an envelope in which to seal the

fingerprint card and this form?

Please be sure that you:

Complete and initial the three steps above;

Please do not fold, hole-punch, or otherwise damage the fingerprint card;

Sign the fingerprint card;

Sign this form below; and

Remember to initial the outside flap of the envelope after sealing it.

______________________________________________ _____________________

Authorized Fingerprinting Agent’s Signature

Date

______________________________________________

Name (Please print or type)

______________________________________________

Police Agency/ School District/ Institution

DO NOT FORGET TO SEAL THIS FORM WITH THE FINGERPRINT CARD IN A

SINGLE ENVELOPE AND THEN INITIAL THE OUTSIDE FLAP

P a g e

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Fingerprint Handler Sheet -Teacher Standards And Practices Commission Page 2