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Record Information from the City School 2023-2026

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OSPRA 104 10/07 Authorization to Forward Criminal History Record Information from the City School District of the City of New York to the New York State Education Department Office of School Personnel Review and Accountability NYS Education Department ph 518 473-2998 www. Highered.nysed.gov/tcert/ospra OSPRA mail.nysed.gov Type or Print All Information Instructions to Applicant Please complete Sections 1 2 and 3 and mail the form to the address in Section 4. Please Note This form is to be filed by individuals who have been previously fingerprinted after July 1 1990 for a license and/or employment by the New York City Board of Education NYCBOE and are authorizing the NYCBOE to forward their criminal history to the New York State Education Department for certification application and/or employment purposes. SECTION 1 Inaccurate or incomplete information will delay processing Name Last First Middle Sex M/F Home Address Street Apt. Social Security Number City State Zip Telephone Area Code and Number E-mail Address Date of Birth Month Day Year Please choose one of the following I am leaving or have left the employ of the NYCBOE and am seeking clearance for certification and/or employment. I am remaining in the employ of the NYCBOE and I am seeking clearance for certification* the NYCBOE* I hereby authorize the NYCBOE to forward the content of my criminal history record as secured from DCJS and the FBI to the New York State Education Department as a condition of my application for certification and/or clearance for employment. I further understand that the NYCBOE is authorized to forward subsequent criminal history notifications received from DCJS to the New York State Education Department. I understand that if my fingerprints have not been retained by DCJS I will have to be fingerprinted again to meet the requirements of Chapter 180 of the Laws of 2000. prospective employer before a clearance will be issued* Signature Date Division of Human Resources MAIL TO HR Connect Walk-in Center 65 Court Street Room 102 Brooklyn New York 11201 Ph 718 935-4000 Fax 718 935-2726. Please Note This form is to be filed by individuals who have been previously fingerprinted after July 1 1990 for a license and/or employment by the New York City Board of Education NYCBOE and are authorizing the NYCBOE to forward their criminal history to the New York State Education Department for certification application and/or employment purposes. SECTION 1 Inaccurate or incomplete information will delay processing Name Last First Middle Sex M/F Home Address Street Apt. SECTION 1 Inaccurate or incomplete information will delay processing Name Last First Middle Sex M/F Home Address Street Apt. Social Security Number City State Zip Telephone Area Code and Number E-mail Address Date of Birth Month Day Year Please choose one of the following I am leaving or have left the employ of the NYCBOE and am seeking clearance for certification and/or employment. Social Security Number City State Zip Telephone Area Code and Number E-mail Address Date of Birth Month Day Year Please choose one of the following I am leaving or have left the employ of the NYCBOE and am seeking clearance for certification and/or employment. I am remaining in the employ of the NYCBOE and I am seeking clearance for certification* the NYCBOE* I hereby authorize the NYCBOE to forward the content of my criminal history record as secured from DCJS and the FBI to the New York State Education Department as a condition of my application for certification and/or clearance for employment.

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Understanding the OSPRA 104 Form

The OSPRA 104 form is a critical document used in the fingerprinting process for individuals applying for positions within the New York City Department of Education (DOE). This form is essential for conducting background checks, ensuring that all personnel meet the necessary safety and legal standards. The OSPRA 104 form is specifically designed to collect personal information and consent for fingerprinting, which is a key requirement for various educational roles.

Steps to Complete the OSPRA 104 Form

Completing the OSPRA 104 form involves several straightforward steps:

  1. Gather necessary personal information, including your full name, address, date of birth, and Social Security number.
  2. Read the instructions carefully to understand the consent requirements and the purpose of the fingerprinting.
  3. Fill out the form accurately, ensuring all sections are completed to avoid delays.
  4. Sign and date the form to confirm your consent for the background check.
  5. Submit the completed form to the appropriate department or designated location as instructed.

Legal Use of the OSPRA 104 Form

The OSPRA 104 form is used in compliance with state regulations governing background checks for educational employees. It is a legal requirement that helps protect students and staff by ensuring that individuals with criminal backgrounds are not placed in positions of trust. Understanding the legal implications of this form is crucial for applicants, as it involves consent for the release of sensitive information.

Required Documents for Submission

When submitting the OSPRA 104 form, additional documentation may be required. Commonly required documents include:

  • Government-issued identification, such as a driver's license or passport.
  • Proof of residency, which may include utility bills or lease agreements.
  • Any previous background check results, if applicable.

Ensuring that all required documents are included with the OSPRA 104 form can expedite the processing time.

Form Submission Methods

The OSPRA 104 form can be submitted through various methods, depending on the requirements of the specific department. Common submission methods include:

  • Online submission through the designated portal for the NYC DOE.
  • Mailing the completed form to the appropriate office address.
  • In-person drop-off at designated locations, which may offer immediate processing.

Choosing the correct submission method is important to ensure timely processing of your application.

Eligibility Criteria for the OSPRA 104 Form

To be eligible to complete and submit the OSPRA 104 form, applicants must meet specific criteria, which typically include:

  • Being a prospective employee of the New York City Department of Education.
  • Having a valid Social Security number.
  • Being of legal age to provide consent for fingerprinting.

Meeting these criteria is essential for the successful processing of the OSPRA 104 form.

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VersionsForm popularityFillable & printable
*2007 NY OSPRA 104 [2007-10] 20234.7 Satisfied (108 Votes)
*2007 NY OSPRA 104 [2007-10] 20214.8 Satisfied (1110 Votes)
*2007 NY OSPRA 104 [2007-10] 20074.8 Satisfied (21425 Votes)
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  2. Choose the My Signature button.
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Related links to Record Information From The City School
Student Records Request Form

Section 2: High School Information. Name of Last NYC High School Attended. School Address. District Number. Borough. School Number. Is this school still open?

Requesting Student Records and Transcripts

Former students must print and fill out the Student Records Request Form, below, to make a request for records, including transcripts.

City University of New York

Jul 25, 2024 — The City University of New York (CUNY)[3] It is the largest public university in the United States and the fourth largest public university ...

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