FORMS AND INSTRUCTIONS CRIMINAL HISTORY CHECKS CONTRACTORS SERVICE PROVIDERS

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Plano Independent School District
Safety and Security Services
CRIMINAL HISTORY CHECKS
for
CONTRACTORS
and
SERVICE PROVIDERS
FORMS AND INSTRUCTIONS
June 29, 2015
Introduction
This document summarizes the District’s procedures concerning fingerprinting and
criminal history checks for Contractors and Service Providers who may have direct contact
with students. For additional information, please refer to District Policy CJA (Legal).
Contractors/Service Providers vs. Volunteers
The information in this document DOES NOT APPLY to Volunteers. Most
Volunteers are not required to be fingerprinted and must only complete the online
Volunteer application.
Who Must Be Fingerprinted
Contractors or service providers who may have direct contact with students (as
specifically defined below) are required to be fingerprinted and complete the paperwork
described in this document.
“Direct contact with students” means contact that results from activities that provide
substantial opportunity for verbal or physical interaction with students and that is not
supervised by a certified educator or other professional district employee. Contact with
students that results from services that do not provide substantial opportunity for unsupervised
interaction with a student or students, such as addressing an assembly, officiating a sports
contest, or judging an extracurricular event, is not, by itself, direct contact with students.
However, direct contact with students does result from any activity that provides substantial
opportunity for unsupervised contact with students, which might include, without limitation, the
provision of coaching, tutoring, or other services to students.
Contractors or service providers who perform services on PISD property but who do not
have direct contact with students (as defined above) are not ordinarily required to submit to
fingerprinting, but may be required to submit to a criminal history check.
Please Note: The District remains the final arbiter of what constitutes “direct contact
with students” and who must submit to a fingerprint-based or other criminal history
check. The District may require a fingerprint-based or other criminal history check
when doing so is in the best interest of students and the District.
Returning Contractors - Must Re-Submit Packet Each Year
A contractor/service provider must only be fingerprinted once, not annually. However,
the District de-authorizes all contractors on June 30th of each year. In order to renew their
approval, returning (previously approved) contractors/service providers must submit a new
Packet 1 or Packet 2 each year. Fingerprinting need not be repeated.
Page 2
Allow at Least Ten (10) Business Days for Review and Approval
We need at least ten (10) business days to review and approve a new or returning
contractor or service provider. Please have the required Packet 1 or Packet 2 submitted at
least 10 days before you expect to utilize the services of a contractor/service provider who has
direct contact with students.
On June 30th of each year, all previously approved contractors and service providers will
be de-authorized (purged) from our approved list.

New contractors/service providers who are required to have a fingerprint-based criminal
history check must: a) be fingerprinted; and b) submit the proper information packet
(Packet 1 or Packet 2) at least ten (10) business days before they begin performing
services.

Returning contractors/service providers (who have been previously fingerprinted) must
submit a new information packet (Packet 1 or Packet 2) at least ten (10) business days
before they resume performing services.

Unsupervised contractors and service providers may not have direct contact with
students until they have been approved by Security and appear on the approved list.

We will not proceed with approving a contractor or service provider until we have
received a complete Packet 1 or Packet 2.
Page 3
Overview of Specific Responsibilities
Campus or Sponsoring District Department
1. Provide this information packet to contractors or service providers your department or
campus will be using.
2. Collect and review completed forms (Packet 1 or Packet 2) from your contractor or
service provider.
3. Complete the coversheet checklist.
4. Forward the completed Packet 1 or Packet 2 to Safety and Security Services at least 10
business days prior to the start date of the contractor/service provider’s services.
5. Check list of “Approved Persons” on inside.pisd to confirm completion of criminal history
check
6. Promptly notify Safety and Security when a contractor/service provider is no longer
providing services.
Contractors and Service Providers
1. Receive this information packet from campus or sponsoring District department.
2. Follow instructions, complete fingerprinting and complete forms in Packet 1 or Packet 2.
3. Submit completed Packet 1 or Packet 2 to the campus or sponsoring District
department that is using your services.
4. Contact the campus or sponsoring District department to confirm approval
5. If any individual is not approved, have that individual contact Safety and Security
Services to discuss.
6. Promptly notify Safety and Security Services if contractor’s employee is no longer
providing services.
Safety and Security Services
1. Receive completed Packet 1 or Packet 2 from campuses and sponsoring District
departments
2. Verify that listed individuals have completed criminal history check
3. Review any reported criminal history and determine if individuals is eligible or ineligible
to serve as a contractor or service provider
4. Post names of individuals whose are eligible to serve as a contractor or service provider
on “Approved List”.
5. Discuss ineligibility with disqualified individual (only) if requested.
6. Assist campuses and District departments with determining what type of criminal history
check is required.
If a question arises about what type of criminal history check is required, the campus or
District department (not the Contractor or Service Provider) should contact Safety and
Security Services for assistance in making this determination. Contractors and Service
providers must not contact Safety and Security Services directly for this determination.
The contractor/service provider’s point of contact is the sponsoring campus or District
Department.
Page 4
Instructions To PISD Departments and Campuses
1.
Provide this information packet (and attached forms/instructions) to the contractor or
service provider you are utilizing.
2.
Inform the contractor/service provider to review the instructions and follow the steps
listed under INSTRUCTIONS TO CONTRACTOR OR SERVICE PROVIDER.
3.
Collect completed forms (Packet 1 or Packet 2) from your contractor or service provider.
4.
Review all forms to ensure completeness.
5.
Complete the checklist on the coversheet of the packet - be sure to include your
name, campus/department, and your contact information.
6.
Submit complete forms packet (completed Packet 1 or Packet 2) to Safety and Security
Services
7.
Check the list of “Eligible Persons” (which is updated each week) and posted on
Inside.PISD at: http://inside.pisd/district_services/security/SecurityForms.shtml
IF YOU NEED ASSISTANCE
If a Campus or District Department needs assistance regarding these procedures or
other questions regarding criminal history check requirements or procedures, please contact
the following Safety and Security Services personnel:



Support Specialist Terri Klein: [email protected] / 469-752-8919
Support Specialist Annette Rivas: [email protected] / 469-752-8159
Office Manager, Safety and Security Services: 469-752-8057
REMEMBER:
THE MOST IMPORTANT FACTOR IN DETERMING WHETHER A CONTRACTOR OR
SERVICE PROVIDER MUST BE FINGERPRINTED IS THE LEVEL OF POTENTIAL
CONTACT THE INDIVIDUAL WILL HAVE WITH OUR STUDENTS AND WHETHER THEY
WILL BE SUPERVISED AT ALL TIMES BY A PROFESSIONAL PISD EMPLOYEE. IN
“CLOSE CASES” THE INDIVIDUAL SHOULD BE REQUIRED TO SUBMIT TO
FINGERPRINTING.
SAFETY AND SECURITY SERVICES DOES NOT EVALUATE THE QUALIFICATIONS OR
SUITABILITY OF ANY PARTICULAR CONTRACTOR OR SERVICE PROVIDER. SAFETY
AND SECURITY SERVICES’ ROLE IS LIMITED TO CONFIRMING THAT CRIMINAL
HISTORY CHECKS HAVE BEEN PERFORMED ON COVERED PERSONS AND THAT
INDIVIDUALS DO NOT HAVE DISQUALIFYING CRIMINAL HISTORY.
Page 5
INSTRUCTIONS TO
CONTRACTOR OR SERVICE PROVIDER
You must first determine whether you are required to complete Packet 1 or Packet 2 by
reviewing the following steps:
Step 1:
Consider these factors:

Is your written or verbal agreement (to provide services) directly with PISD?
Example: Agreement with campus to provide photography services.

Is your written or verbal agreement (to provide services) with a person, entity or group
other than PISD?
Example: Agreement with PTA or Booster Club to provide after-school activities on
campus.

Are you a company with 2 or more employees, including yourself?
Example: Super Nurses, Inc., has 3 employees who provide private duty nursing.

Are you an individual (no company) or a company consisting of only yourself?
Example: John Smith teaches private music lessons; or, John’s Super Tutors, LLC, has
only one employee/owner (John Baker) who provides private tutoring on campus.
Step 2:
Answer the Following Questions:
1)
Is your written or verbal agreement directly with PISD?
Yes
2)
Are you a company that has 2 or more employees, including you?
No
Yes
No
If you answered “yes” to BOTH questions, complete PACKET 1.
If you answered “no” to either question (or to both questions), complete PACKET 2.
Step 3:
Complete Packet 1 or Packet 2 as applicable.
packet.
Additional instructions are in each
For Renewals Only:
All approved contractors/service providers are de-authorized on June 30th of each year.
If you were previously approved and are returning to provide services after June 30th of each
year, you must submit a new Packet 1 or Packet 2. You do not have to be re-fingerprinted.
Page 6
Criminal History
PACKET 1
CHECKLIST FOR PISD USE ONLY
INSTRUCTIONS: The checklist below should be completed by the PISD
Campus or Department utilizing the services of the contractor/service
provider. This checklist and each document listed below should be
submitted to Safety and Security Services at least 10 business days in
advance of services being provided.
__________________
Today’s Date
Attached:
_____ Certification of Compliance (FORM A)
_____ Roster of Persons Fingerprinted (FORM B)
________________________________________________
PISD Campus or Department
Phone
________________________________________________
Name of Contact Person at Campus / Department
PACKET 1 - INSTRUCTIONS - Page 1
Revised 06/29/2015
PLANO INDEPENDENT SCHOOL DISTRICT
SAFETY AND SECURITY SERVICES
PACKET NO. 1- INSTRUCTIONS
(FOR COMPANIES WITH 2 OR MORE EMPLOYEES AND A VERBAL OR WRITTEN
AGREEMENT WITH PISD TO PROVIDE SERVICES - DIRECT CONTACT WITH
STUDENTS)
PLEASE COMPLETE THE FOLLOWING STEPS:
1.
Set up Account with DPS to obtain fingerprinting and Criminal History Checks.
Companies with employees who will have direct contact with students (as previously
defined) must obtain the required criminal history background checks through the Texas
Department of Public Safety’s (“DPS”) Fingerprint-based Applicant Clearinghouse of Texas
(“FACT”). In order to do so, the company must set up an account with DPS for FACT
Clearinghouse access. To set up the required account, contact:
Access and Dissemination Bureau
Texas Department of Public Safety
Crime Records Service
Email: [email protected]
Telephone: (512) 424-2474 (select option No. 2)
The DPS FACT Clearinghouse will provide instructions on how to obtain the required
fingerprints and to have them submitted to DPS. Fingerprints are taken at a DPS vendor with
several area locations. DPS will provide instructions on fingerprinting appointments.
PLEASE NOTE: If you have a written agreement with PISD to provide services, you will need
to provide a copy of it to DPS. If you do not have a written agreement but have a verbal
agreement with PISD to provide services, complete and submit the “Letter of Agreement”
which is included in this packet. Both you and your sponsoring campus or District department
will need to sign this Letter of Agreement.
2.
Complete fingerprinting of all individuals who will have direct contact with
students. Do not submit your forms packet until fingerprinting has been completed.
3.
Complete the Certification of Compliance (FORM A) included in this packet.
4.
Complete the Roster of Persons Fingerprinted (FORM B) included in this packet.
5.
Submit the completed packet of forms to the Campus or District Department you
received them from. Do not submit documents directly to Safety and Security
Services. Do not submit your packet until each person listed on the Roster of Persons
Fingerprinted has been fingerprinted.
PACKET 1 - INSTRUCTIONS - Page 2
Revised 06/29/2015
6.
Contact the Campus or District Department you submitted your packet to in order
to confirm your employees (or you) are approved to perform services.
REMINDERS AND HELPFUL INFORMATION

Completed packets must be received by Safety and Security Services at least ten (10)
business days prior to the date services are provided by the contractor/service provider.
During peak season, the fingerprinting vendor used by DPS may have a shortage of
available appointments. Please plan accordingly.

Please do not submit separate or individual forms - submit only complete packets
(Packet 1 or Packet 2).

On June 30th of each year, all previously approved individuals are de-authorized.
Individuals who will be returning to provide services after June 30th of each year (and
who have previously been approved) do not have to be fingerprinted again. However, a
new Packet 1 or Packet 2 must be submitted.

If an individual is not approved due to a criminal history issue, that individual must
contact Safety and Security Services at 469-752-8057 to discuss the issue. We cannot
discuss a person’s criminal history record with anyone other than the person who the
record applies to.
PACKET 1 - INSTRUCTIONS - Page 3
Revised 06/29/2015
FORM A
PLANO INDEPENDENT SCHOOL DISTRICT
SAFETY AND SECURITY SERVICES
CERTIFICATION OF COMPLIANCE
BY CONTRACTOR OR SERVICE PROVIDER
Definitions:
Covered Persons: Persons who, as an independent contractor or employee of a
contractor or subcontractor who have or will have continuing duties related to the service
to be performed at PISD and have or will have direct contact with students. PISD will be
the final arbiter of what constitutes continuing duties or direct contact with students.
Disqualifying Criminal History: (a) Conviction, probation or adjudication for any offense
against a child, any sexual offense, any offense involving an act (or threat) of violence,
or injury or death of a person, any weapons related offense, any felony offenses
involving drugs or controlled substances, any felony offenses against property, any
active warrant of arrest or charges pending on any criminal violation, or any other
offense the Executive Director of Safety and Security Services believes may
compromise the safety, security, or well-being of students, staff, or facilities or which
violates District Policy; (b) an arrest for any of the preceding offenses where the conduct
underlying the arrest indicates the Covered Person is not suitable to serve as a
contractor or service provider; (c) an excessive number of arrests regardless of type,
where the circumstances or pattern of arrests indicates the Covered Person is not
suitable to serve as a contractor or service provider; or (d) required registration as a sex
offender.
I, ______________________________________________,
Independent School District (“PISD”): [check one]:
[
]
certify
to
the
Plano
On behalf of ____________________________________________ [name of
company, if any], as a Contractor or Subcontractor to PISD, all required
fingerprinting and criminal history record information has been obtained for each
employee who is a Covered Person as defined above.
--OR--
[
]
As an Independent Contractor who is a Covered Person as defined above, I
have been fingerprinted and have obtained all required criminal history record
information on myself.
I further certify that:
(1)
Neither I nor any my employees who are Covered Persons have Disqualifying
Criminal History.
CERTIFICATION OF COMPLIANCE
Page 1
Revised 06/29/2015
(2)
If I receive information that a Covered Person, including myself, subsequently
has a reported criminal history, I will immediately remove the Covered Person, including
myself, from contract duties at PISD and will notify PISD in writing within three (3)
business days.
(3)
I agree to provide PISD with the full name and any other required information of
Covered Persons, including myself, so that PISD may review criminal history record
information on the covered employees. If PISD objects to the assignment of a Covered
Person, including myself, on the basis of the Covered Person’s criminal history record
information, I agree to discontinue using that covered person, including myself, to
provide services at PISD. It is expressly understood that PISD may disqualify a Covered
Person on the basis of: (a) a conviction or criminal history information designated by
PISD; or (b) any other offense that the PISD Director of Safety and Security Services
believes may compromise the safety, security, or well being of students, staff, or facilities
or violates District Policy.
(4)
In the event a Covered Person, including myself, ceases to perform services at
PISD events and facilities, I agree to notify PISD of the termination of services in writing
within five (5) business days.
(5)
If I am executing this certification form on behalf of an entity that employs
subcontractors who employs Covered Persons, I certify that I have obtained the
certifications of compliance from such subcontractors.
I further agree and understand that non-compliance or misrepresentations
regarding this Certification may be grounds for immediate contract termination.
__________________________________
Signature
______________________
Date
__________________________________
Printed Name
______________________
Title
CERTIFICATION OF COMPLIANCE
Page 2
Revised 06/29/2015
FORM B
Page _____ of _______
ROSTER OF PERSONS FINGERPRINTED

EACH PERSON MUST INITIALLY BE FINGERPRINTED FOR THE SPECIFIC PURPOSE OF SERVING AS A SCHOOL DISTRICT CONTRACTOR.
FINGERPRINTING FOR OTHER PURPOSES (CHL LICENSE, NURSING LICENSE, MILITARY SERVICE, ETC.) IS NOT ACCEPTABLE.

FINGERPRINTING IS REQUIRED ONLY ONCE - NOT ANNUALLY.
NAME OF CONTRACTOR/SERVICE PROVIDER:___________________________________________________________
NAME OF PERSON COMPLETING THIS ROSTER:_________________________________________________________
Name of Individual(s) Fingerprinted
(Provide Full Legal Name)
Race
Gender
Date of Birth
State and Number of ID
Card or Driver’s
License
Check this Box if
Individual is Returning
and was previously
fingerprinted
Revised 06/29/2015
DO NOT SUBMIT THIS ROSTER UNLESS EACH PERSON LISTED HAS COMPLETED FINGERPRINTING!
LETTER OF AGREEMENT
(BEHIND THIS COVER PAGE)
Note:
DPS will require the company
contracting with Plano ISD to provide a copy of
the company’s written contract or agreement.
If your company does not have a written
contract or agreement, but has a verbal
agreement, you may submit this Letter of
Agreement to DPS instead.
Instructions:
Contractor: Add date, name of company and
have company representative sign in the space
provided.
Campus/District Department: Have campus
or department administrator sign in the space
provided.
____________________________
Date
Texas Department of Public Safety
Crime Records Service
Access and Dissemination Bureau
Re: Letter of Agreement - Plano ISD and Contractor
Dear Sir or Madam:
This letter will confirm that the Plano Independent School District (PISD) and
____________________________________________(Contractor)
have
reached
an
agreement whereby the Contractor will provide services to PISD pursuant to such agreement.
______________________________
Contractor - Signature
_______________________________
PISD Administrator - Signature
______________________________
Contractor - Printed Name
_______________________________
PISD Administrator - Printed Name
ADMINISTRATION BUILDING
2700 W. 15
TH
STREET PLANO, TEXAS 75075
PHONE: (469) 752-8000
Criminal History
PACKET 2
CHECKLIST FOR PISD USE ONLY
INSTRUCTIONS: The following checklist should be completed by the PISD
Campus or Department utilizing the services of the contractor/service
provider. This checklist and each document listed below should be
submitted to Safety and Security Services at least 10 business days in
advance of services being provided.
__________________
Today’s Date
Attached:
_____ Certification of Compliance (FORM A)
_____ Roster of Persons Fingerprinted (FORM B)
_____ Consent for Criminal History Check (FORM C)
________________________________________________
PISD Campus or Department
Phone
________________________________________________
Name of Contact Person at Campus / Department
PACKET 2 - INSTRUCTIONS - PAGE 1
Revised 06/29/2015
PLANO INDEPENDENT SCHOOL DISTRICT
SAFETY AND SECURITY SERVICES
PACKET NO. 2 - INSTRUCTIONS
(FOR USE BY: a) INDIVIDUALS OR COMPANIES WITH ONLY 1 EMPLOYEE; AND b)
COMPANIES WITH 2 OR MORE EMPLOYEES WHOSE VERBAL OR WRITTEN
AGREEMENT TO PROVIDE SERVICES IS WITH AN ENTITY OTHER THAN PISD)
PLEASE COMPLETE THE FOLLOWING STEPS:
1.
Locate the Generic Fast Pass included in this packet. Follow the instructions on the
Fast Pass and complete fingerprinting of all individuals who will have direct contact with
students.
2.
Complete the Certification of Compliance Form (FORM A) included in this packet.
3.
Complete the Roster of Persons Fingerprinted (FORM B) included in this packet.
4.
Complete the Consent for Criminal History Check (FORM C) included in this
packet.
5.
Submit the completed packet of forms to the Campus or District Department you
received them from. Do not submit documents directly to Safety and Security
Services. Do not submit your packet until each person listed on the Roster of Persons
Fingerprinted has been fingerprinted.
6.
Contact the Campus or District Department you submitted your packet to in order
to confirm you or your employees are approved to provide services.
REMINDERS AND HELPFUL INFORMATION

Complete packets must be received by Safety and Security Services at least ten (10)
business days prior to the date services are provided by the contractor/service provider.
During peak season, the fingerprinting vendor used by DPS may have a shortage of
available appointments. Please plan accordingly.

On June 30th of each year, all previously approved individuals are de-authorized.
Individuals who will be returning to provide services after June 30 th of each year (and
who have previously been approved) do not have to be fingerprinted again. However, a
new Certification Form and a new Roster must be submitted.

If an individual is not approved due to a criminal history issue, that individual must
contact Safety and Security Services at 469-752-8057 to discuss the issue. We cannot
discuss a person’s criminal history record with anyone other than the person who the
record applies to.
PACKET 2 - INSTRUCTIONS - PAGE 2
Revised 06/29/2015
GENERIC FAST PASS
(Local Education Entity)
Plano ISD
This document is your FAST Fingerprint Pass for a state and national criminal history record check. Please schedule a
fingerprint appointment by visiting http://www.identogo.com or by calling 1-888-467-2080. When scheduling an
appointment you will be prompted by IdentoGO for the following additional personal data: Date of Birth, Sex,
Race, Ethnicity, Skin Tone, Height, Weight, Eye Color, Hair Color, Place of Birth and Home Address. During
your Fingerprint appointment you will also be prompted for Social Security Number and Driver License
Number. Requested data is required by the Texas Department of Public Safety to process your background check. These data elements have
been omitted from this document in order to better protect the security of your personal information. You may pay for FAST services online with a credit
card or onsite with a check or money order only. Your fingerprints will be submitted to the Texas Department of Public Safety and the Federal Bureau of
Investigation.
1.
2.
3.
4.
5.
Logon to http://www.identogo.com
Select: Texas
Select: Online Scheduling
Select: English or Espanol
Enter: First and Last Name
6.
7.
8.
9.
Select: Education
Enter: TX923467Z when prompted for Agency number/ORI
Enter: TX920520Z when prompted for Agency ORI
Follow the prompts to enter requested information.
10. Bring this completed form with you to your appointment.
Section One: Qualified Entity Information
ORI#: TX923467Z
Agency ORI #: TX920520Z
Original TCN: _______________________________
(If resubmission for rejected fingerprints)
Agency/Entity/Organization Name: _________Plano ISD______________________________________________________
Section Two: Applicant Name (To be completed by applicant)
Last: ______________________________________
(Please print)
First: _________________________________
(Please print)
Middle: ________________________
(Please print)
Section Three: Waiver Information (To be completed and signed by applicant)
I certify that all information I provided in relation to this criminal history record check is true and accurate. I authorize the Texas Department of Public
Safety (DPS) to access Texas and Federal criminal history record information that pertains to me and disseminate that information to the designated
Authorized Agency or Qualified Entity with which I am or am seeking to be employed or to serve as a volunteer, through the DPS Fingerprint-based
Applicant Clearinghouse of Texas and as authorized by Texas Government Code Chapter 411 and any other applicable state or federal statute or policy.
I authorize the Texas Department of Public Safety to submit my fingerprints and other application information to the FBI for the purpose of comparing the
submitted information to available records in order to identify other information that may be pertinent to the application. I authorize the FBI to disclose
potentially pertinent information to the DPS during the processing of this application and for as long hereafter as may be relevant to the activity for which
this application is being submitted. I understand that the FBI may also retain my fingerprints and other applicant information in the FBI’s permanent
collection of fingerprints and related information, where all such data will be subject to comparisons against other submissions received by the FBI and
to further disseminations by the FBI as may be authorized under the Federal Privacy Act (5USC 552a(b)). I understand I am entitled to obtain a copy of
any criminal history record check and challenge the accuracy and completeness of the information before a final determination is made by the Qualified
Entity. I also understand the Qualified Entity may deny me access to children, the elderly, or individuals with disabilities until the criminal history record
check is completed. If a need arises to challenge the FBI record response, you may contact the agency that submitted the information to the FBI, or you
may send a written challenge request to the FBI's Criminal Justice Information Services (CJIS) Division at FBI CJIS Division, Attention: Correspondence
Group, 1000 Custer Hollow Road, Clarksburg, WV 26306.
Signature: ______________________________________________________
Date: __________________________________________
Section Four: Service Center Information (To be completed by FAST Enrollment Agent)
Date Prints Taken _______________________
Paid by:
 Check
 Money Order
 Visa
Amount Charged For Service: _$41.45____
 MasterCard
 Billing Acct _____________________________________________________
TCN: ____________________________________________________________
I HAVE COMPARED THE GOVERNMENT-ISSUED IDENTIFICATION PRESENTED BY THE APPLICANT AND ATTEST THAT TO MY BEST
DETERMINATION; I HAVE FINGERPRINTED THE SAME PERSON.
E.A. Name: ________________________________________________
E.A. Signature: ________________________________________________
(Please print)
Revised 06/13
FORM A
PLANO INDEPENDENT SCHOOL DISTRICT
SAFETY AND SECURITY SERVICES
CERTIFICATION OF COMPLIANCE
BY CONTRACTOR OR SERVICE PROVIDER
Definitions:
Covered Persons: Persons who, as an independent contractor or employee of a
contractor or subcontractor who have or will have continuing duties related to the service
to be performed at PISD and have or will have direct contact with students. PISD will be
the final arbiter of what constitutes continuing duties or direct contact with students.
Disqualifying Criminal History: (a) Conviction, probation or adjudication for any offense
against a child, any sexual offense, any offense involving an act (or threat) of violence,
or injury or death of a person, any weapons related offense, any felony offenses
involving drugs or controlled substances, any felony offenses against property, any
active warrant of arrest or charges pending on any criminal violation, or any other
offense the Executive Director of Safety and Security Services believes may
compromise the safety, security, or well-being of students, staff, or facilities or which
violates District Policy; (b) an arrest for any of the preceding offenses where the conduct
underlying the arrest indicates the Covered Person is not suitable to serve as a
contractor or service provider; (c) an excessive number of arrests regardless of type,
where the circumstances or pattern of arrests indicates the Covered Person is not
suitable to serve as a contractor or service provider; or (d) required registration as a sex
offender.
I, ______________________________________________,
Independent School District (“PISD”): [check one]:
[
]
certify
to
the
Plano
On behalf of ____________________________________________ [name of
company, if any], as a Contractor or Subcontractor to PISD, all required
fingerprinting and criminal history record information has been obtained for each
employee who is a Covered Person as defined above.
--OR--
[
]
As an Independent Contractor who is a Covered Person as defined above, I
have been fingerprinted and have obtained all required criminal history record
information on myself.
I further certify that:
(1)
Neither I nor any my employees who are Covered Persons have Disqualifying
Criminal History.
CERTIFICATION OF COMPLIANCE
Page 1
Revised 06/29/2015
(2)
If I receive information that a Covered Person, including myself, subsequently
has a reported criminal history, I will immediately remove the Covered Person, including
myself, from contract duties at PISD and will notify PISD in writing within three (3)
business days.
(3)
I agree to provide PISD with the full name and any other required information of
Covered Persons, including myself, so that PISD may review criminal history record
information on the covered employees. If PISD objects to the assignment of a Covered
Person, including myself, on the basis of the Covered Person’s criminal history record
information, I agree to discontinue using that covered person, including myself, to
provide services at PISD. It is expressly understood that PISD may disqualify a Covered
Person on the basis of: (a) a conviction or criminal history information designated by
PISD; or (b) any other offense that the PISD Director of Safety and Security Services
believes may compromise the safety, security, or well being of students, staff, or facilities
or violates District Policy.
(4)
In the event a Covered Person, including myself, ceases to perform services at
PISD events and facilities, I agree to notify PISD of the termination of services in writing
within five (5) business days.
(5)
If I am executing this certification form on behalf of an entity that employs
subcontractors who employs Covered Persons, I certify that I have obtained the
certifications of compliance from such subcontractors.
I further agree and understand that non-compliance or misrepresentations
regarding this Certification may be grounds for immediate contract termination.
__________________________________
Signature
______________________
Date
__________________________________
Printed Name
______________________
Title
CERTIFICATION OF COMPLIANCE
Page 2
Revised 06/29/2015
FORM B
Page _____ of _______
ROSTER OF PERSONS FINGERPRINTED

EACH PERSON MUST INITIALLY BE FINGERPRINTED FOR THE SPECIFIC PURPOSE OF SERVING AS A SCHOOL DISTRICT CONTRACTOR.
FINGERPRINTING FOR OTHER PURPOSES (CHL LICENSE, NURSING LICENSE, MILITARY SERVICE, ETC.) IS NOT ACCEPTABLE.

FINGERPRINTING IS REQUIRED ONLY ONCE - NOT ANNUALLY.
NAME OF CONTRACTOR/SERVICE PROVIDER:___________________________________________________________
NAME OF PERSON COMPLETING THIS ROSTER:_________________________________________________________
Name of Individual(s) Fingerprinted
(Provide Full Legal Name)
Race
Gender
Date of Birth
State and Number of ID
Card or Driver’s
License
Check this Box if
Individual is Returning
and was previously
fingerprinted
Revised 06/29/2015
DO NOT SUBMIT THIS ROSTER UNLESS EACH PERSON LISTED HAS COMPLETED FINGERPRINTING!
FORM C
CONSENT FOR CRIMINAL HISTORY RECORD CHECK
I, _______________________________________________, hereby authorize
the Plano Independent School District to conduct a criminal history record check
through the Texas Department of Public Safety, and which includes, but may not
be limited to, performing a finger-print based, national criminal history record
check, in connection with my request to work or provide services, whether for
compensation or on a volunteer basis, to PISD students and/or at PISD facilities.
I authorize any law enforcement agency, including the Texas Department of
Public Safety and the Federal Bureau of Investigation, to release any reported
criminal history concerning me to the Plano Independent School District.
___________________________________________
Signature
___________________________________________
Printed Name – First Middle Last
___________________________________________
Date
A CONSENT FORM MUST BE SUBMITTED FOR EACH PERSON
Revised 06/29/2015
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