JC CBC 4 Applicant Consent for FP Form 2025

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4 out of 5

38 votes

The document is an Applicant Consent Form for fingerprinting required by the Justice Center for conducting a Criminal Background Check (CBC). It outlines the applicant's personal information, attestation of consent for background checks with the NYS Division of Criminal Justice Services and FBI, rights regarding criminal history information, and confidentiality assurances. The form also includes sections for the applicant to disclose any criminal convictions or pending charges and requires signatures from both the applicant and a parent/guardian if under 18.

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Click ‘Get Form’ to open the JC CBC 4 Applicant Consent for FP Form in our editor.
Begin by filling out Part 1: Applicant Information. Enter your last name, first name, middle initial, date of birth, social security number, and address. Specify your applicant type and the facility/provider.
Proceed to Part 2: Attestation. Carefully read each statement and check the appropriate boxes regarding your criminal history. Ensure you provide accurate information about any convictions or pending charges.
Sign and date the form at the bottom of Part 2. If you are under 18, a parent or guardian must also sign.
Complete Part 3 by entering the authorized person's information from the facility or provider agency, including their name, title, email, and signature.
Once all sections are filled out accurately, review your entries for completeness before saving or printing the document.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (155 Votes)
2014	4 Satisfied (38 Votes)

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