I understand that my personal information including name, date of birth, social security number and fingerprints will be used for the purpose of conducting a criminal history records search through any applicable state and federal databases. This information will be used by the Department of Human Services, Office of Licensing to determine my eligibility to have direct access to a child or vulnerable adult. My personal information and fingerprints may be retained for ongoing monitoring and comparison against future submissions to the state, regional or federal database and latent fingerprint inquiries. The Department of Human Services, Office of Licensing will establish procedures to ensure removal of my fingerprints from applicable state and federal databases when I am no longer under their purview. I understand that I may request to review any results of this inquiry and understand that UCA 53-10-108 does not allow the Department of Human Services, Office of Licensing to provide a copy of those results to me. Before a determination is made, I understand that I will be afforded a reasonable amount of time to challenge the completeness and accuracy of the record through the procedures established by the Department of Human Services, Office of Licensing as well as contacting the Utah Bureau of Criminal Identification (Utah Criminal History Results), the State Identification Bureau (SIB) associated with any results that are outside of Utah, or the Federal Bureau of Investigation (Nationwide Criminal History Response Information). I have read the attached Privacy Statement and understand my rights according to this statement.
By signing this form, the applicant authorizes Morning Sun Financial Services, the State of Utah Department of Human Services, Office of Licensing as well as the Utah Bureau of Criminal Identification to release information to the self-directed program with the State of Utah and my prospective employer as it pertains to my potential employment. The applicant understands that employment is dependent on an approved background check. Also, by signing this form, I certify the information I provided on this form is true and correct and I acknowledge it is unlawful to provide false or misleading information concerning criminal history or security check to an employer. I agree that this Authorization form in original, faxed, photocopied or electronic (including electronically signed) form will be valid for any reports that may be requested.
The information obtained herein will only be used for the purposes of obtaining the background study required by DHS.