FINGERPRINT WAIVER

Please Note: this form generates a signed Michigan RI-088A (02/2017) form in our online employment system. Or you may also download the PDF document and return it by fax or email attachment.

Michigan Waiver Agreement And Statement For Schools

An Individual Applicant's Request for a Fingerprint-Based Criminal History Record Information (CHRI) Background Check Result for a Qualified Entity in Accordance with the Michigan School Volunteer & Employee Criminal History Program

Pursuant to the National Child Protection Act (NCPA) of 1993, as amended by the Volunteers for Children Act (VCA), this form should be completed and signed by every current or prospective employee, volunteer, and contractor/vendor, for whom criminal history records are requested by a qualified entity (i.e. school or management company) under these laws.

I hereby authorize Professional Recruiters Group LLC to receive the results of my state and federal fingerprint-based CHRI background check result for the purpose of evaluating and determining my fitness to have responsibility for the safety and well-being of children or individuals with disabilities. Prior to submitting my fingerprints to the Michigan State Police to conduct a CHRI background check, I will complete, sign, and return this form and a Livescan Fingerprint Background Check Request form (Rl-030). I understand the Qualified Entity will retain all required documentation for a period of time no less than prescribed by state or federal laws. By signing this Michigan Waiver Agreement and Statement, it is my intent to authorize the dissemination of any state and national CHRI that may pertain to me to the Qualified Entity with which I am, or am seeking to be, employed or to serve as a volunteer, pursuant to the NCPA VGA.

I understand that until the criminal history background check is completed, the Qualified Entity may choose to deny me unsupervised access to children or individuals with disabilities. I further understand that upon request the Qualified Entity will provide me a copy of the CHRI background results, if any, and that I am entitled to challenge the accuracy and completeness of any information contained in such results. I may obtain a prompt determination as to the validity of my challenge before the Qualified Entity makes a final decision about my status; as an employee, volunteer, contractor, or subcontractor.

Your Information

Full Name(Required)

First Middle Last

Email Address(Required)

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Cell Phone(Required)

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Address(Required)

Street Address City State ZIP Code

Date of Birth(Required)

Have you ever been convicted of a crime?

YES - Conviction

Yes

NO - Conviction

If yes, please provide a description of the crime and the particulars of the conviction.

Signature

Signature(Required)

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Date of Signing(Required)

Michigan State Police

To download the Michigan State Police RI-088A form, click on the image below.