Fillable Sweeny Elementary Fema Safe Room Volunteer Registration Form (Page 3 of 3) in pdf

The purpose of this form is to provide information available to child care agencies including volunteer agencies. The records

you receive will be based on the search options you select. The Missouri State Highway Patrol will respond when you

choose option 1 or 2. The Missouri Childrenʼs Division will respond when you choose option 1, 2, or 3. Direct questions

regarding criminal records to the Missouri State Highway Patrol (573-526-6153); direct questions regarding child abuse or

neglect to the Childrenʼs Division (573-526-1438, TT: 1-800-735-2466).

The information on this form, and responses generated as a result of this form, are confidential. Any person dis-

closing the information in violation of 43.540, 589.400, RSMo. and/or 210.150 RSMo. is guilty of a class A misdemeanor.

For information on how to participate in the Child Abuse/Neglect Central Registry examination program, submit a written

request from the CEO, owner, director, etc. of your child care related group or organization to: Director, Childrenʼs

Division, P.O. Box 88, Jefferson City, MO 65103.

PROCESSING FEE SCHEDULE INFORMATION (43.527 AND 43.530 RSMo.)

By checking boxes 1 thru 3 on the front page of this form, the following applies:

1. Name Search - $10.00 Provides open records obtained from the Missouri Criminal Record Repository and information

from Missouri Childrenʼs Division Central Registry.

a) Complete the request form.

b) Make a check or money order for $10.00 payable to “State of Missouri Criminal Records System.”

c) Mail completed form and check or money order to: Missouri State Highway Patrol, Criminal Justice Information

Services Division, P.O. Box 9500, Jefferson City, MO 65102.

2. Fingerprint Search - $14.00/$20.00 Provides open and closed records with positive identification obtained from the

Missouri Criminal Records Repository and information from Missouri Childrenʼs Division Central Registry.

a) Complete the request form.

b) Obtain fingerprints on: Applicant card FD-258 or Patrol card SHP-152. Official taking fingerprints must verify

identity of person fingerprinted with an official id such as a driverʼs license and sign the card as the person taking

the fingerprints. Complete the rest of the card as applicable.

c) Make a check or money order for $14.00/$20.00 payable to “State of Missouri Criminal Records System.”

d) Mail completed forms and check or money order to: Missouri State Highway Patrol, Criminal Justice Information

Services Division, P.O. Box 9500, Jefferson City, MO 65102.

3. CD Central Registry Child Abuse Search Only - No Charge Provides information obtained from the Childrenʼs Division

Central Registry only. The Childrenʼs Division (CD) Central Registry screening will reflect information contained in the

CD database. Any questions about the accuracy of that information should be directed to the CD office in the residen-

tial county of the applicant or the county of employment if the applicant is not a Missouri resident.

a) Complete the request form.

b) Mail completed form to: Missouri Childrenʼs Division, Background Screening / Investigations Unit, P.O. Box

88, Jefferson City, MO 65103.

OPEN RECORDS - convictions, charges pending, arrests less than thirty days old, and suspended imposition of sentence

during probation.

CLOSED RECORDS - charges not filed, not prosecuted, dismissed, or subject found not guilty or suspended imposition

of sentence after probation.

SPACE RESERVED FOR MSHP/CD RESPONSE STAMP

MO 821-0353 (2-10)

Sweeny Elementary Fema Safe Room Volunteer Registration Form Page 3