Employee Live Scan Verification Form - Diocese Of Sacramento

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DIOCESE OF SACRAMENTO-HUMAN RESOURCE SERVICES
EMPLOYEE LIVE SCAN VERIFICATION FORM
Please fill out the top portion of this form, attach a copy of the Live Scan and return to the
Safe Environment Department.
Fax (916) 733-0195
Last Name
First Name
Initial
Parish/School Site, City
Phone and Fax
Date Fingerprints taken
ATI Number (from Live Scan Form)
----------------------------------------------------------------------------------------------------------------------------
To be completed by the Safe Environment Department and returned to the parish or school.
 EMPLOYEE-FBI and DOJ clearance
 Clearance Received
________
 FBI Date
________
 DOJ Date
________
 Delay
________
Notes:
_______________________________________________
_______________________________________________

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