Free 53390.pdf - Indiana

APPLICANT BACKGROUND RECORD CHECKLIST
State Form 53390 (10-07) Approved by State Board of Accounts, 2007

INDIANA STATE PERSONNEL DEPARTMENT

Reset Form

(attach a copy of the signed disclosure release form)

Name of applicant: Agency: Title of position: Email of requestor:

Date (month,day,year): Account number : Name of requestor: Telephone of requestor:

Records requested (Please attach related documents and return to requestor)
Indiana Department of Revenue Tax Check ­ Free Indiana Sheriffs Sex Offender Registry ­ Free Indiana Bureau of Motor Vehicles Drivers License Check ­ Free BARADA (must be checked if EXBB and/or SPD positions): includes Social Security Number Trace, Criminal County Court Record (also for
Alias), and Criminal Multi-State Record. FEE ASSESSED.

Other BARADA options: (See Reference Page for descriptions and prices for each)
Credit Report (must be checked if business necessity) 3 Reference Exempt Report 3 Reference Midlevel Report 3 Reference Non-Exempt Report Academic ­ US and Canada Academic ­ International Employment ­ US and Canada Employment ­ International Professional License Federal Criminal ­ National Civil Court Record Upper Civil Court Record Lower Fraud and Abuse Search Criminal State Repository

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BACKGROUND CHECK REFERENCE SHEET
SPD will automatically conduct the following searches for EXECUTIVE level and SPD applicants/employees.

TYPE OF SEARCH Tax Payment Check

FEE Free

NOTES
Verification through the Indiana Department of Revenue that applicant/employee is current in payment of Indiana state taxes Obtain a copy of a records check from the Indiana Sex and Violent Offender Directory Database which is maintained by the Indiana Criminal Justice Institute. Verification that the applicant/employee possesses a valid Indiana driver's license. Also includes verifying that applicant/employee's driver's license is current and in good standing and determining status of applicant/employee's driving record. If applicant/employee is not a resident of Indiana, applicant/employee must provide written evidence of this verification in a form provided by the state of residence. Confirm SSN is assigned to applicant/employee. Also verifies counties lived in. PER COUNTY. This is a physical review of criminal county court proceedings performed in each county throughout the country. Information will include records of criminal convictions (misdemeanors and felonies) and/or currently pending criminal charges. Searches cover a 7 year period. *A surcharge could be assessed; however, most counties will not have a surcharge. PER COUNTY PER ALIAS. Information is the same as above, except is specified for an individual's alias name. This is most commonly used for name changes within a 7 year period due to marriage or divorce. *A surcharge could be assessed; however, most counties will not have a surcharge. This is an instant database search of criminal records for 47 states and includes sex offender registries for all 50 states. State databases are compiled from various sources like Department of Corrections or State Police records. Credit history check may be used ONLY where there is a business necessity. The Fair Credit Reporting Act (FCRA) requires a separate written notice and authorization before a report from a consumer reporting agency can be procured. If the employer proposes to deny employment or otherwise adversely affect an employee based on any information contained in a consumer report, the employer must make adverse action disclosures.

Sex Offender Registry

Free

Motor Vehicle Check

Free

Social Security Number Trace Criminal County Court

$4 $12 *

Criminal County Court (Alias)

$12 *

Criminal Multi - State

$18

Credit History

$8

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Additional searches that Barada can conduct if chosen by agency. TYPE OF SEARCH Reference Check 3 Reference- Exempt FEE $372 NOTES
Contact with references provided by applicant/employee. Professional reference interviews geared to CEOs, managers, and other supervisory positions. This report provides a comprehensive evaluation of a candidate's job performance, knowledge, experience, managerial style, growth potential and suitability for the position. This report is for individual contributors without significant managerial responsibilities such as sales representatives and technical staff. This is a narrative report for entry level, factory, clerical and hourly employees. Reference interviews cover basic job skills, work history, dependability, and overall performance. This provides confirmation of enrollment, attendance and/or graduation dates along with degree or certification earned. If a particular school doesn't allow a 3rd party check, the applicant must provide transcripts to verify (a copy of diploma will not suffice).

3 Reference- Midlevel 3 Reference- Non Exempt

$297 $243

Academic Verification

US or Canada International Employment Verification

$10 $35 $10
US/Canada

PER SCHOOL PER COUNTRY plus any surcharges imposed by the country and/or school.

$35*
International

Employment Verification includes verifying identities of employers, applicant/employee's positions and/or titles, dates of employment, salary history, and whether applicant/employee left in good standing. Employment Verification also includes identifying any periods of unemployment over the seven (7) years immediately preceding application and obtaining from applicant/employee explanations for those periods of unemployment. *$35 base rate. Depending on the country, there could be a surcharge also. Confirmation that the applicant/employee possesses all of the professional licenses, certifications or registrations on the application/resume or otherwise necessary for the position and determining the disposition of any proceedings against the license, certification or registration. CHRI Check means the Indiana State Police administers a nationwide criminal history check by accessing a database. This type of criminal history check is limited by federal and state statutes (IC 10-13-3-38.5). An official FBI applicant fingerprint card is necessary to conduct this check. This is a physical review of civil court proceedings in a specified county. Records returned may include foreclosures, civil plenary suits, and civil torts. This is a physical review of civil court proceedings in a specified county. Records returned may include small claim proceedings in which a plaintiff is seeking a money judgment or recovery of personal property limited to a specific monetary level, (differs by state). This is a review of sanction and disciplinary information taken by federal agencies as well as licensing and certification agencies in all 50 states. Many states have instant database searches that are available and cover information from the Department of Corrections and/or State Police records. In states that do not have an instant database, it would be necessary to perform a repository search. Costs will vary and the results typically will not be available for at least 5-7 days.

Professional License Verification

$10

Federal Criminal History Records

$19

Civil Court Upper Search Civil Court Lower Search

$13 $15

Fraud and Abuse Searches Criminal State Repository Search

$9 $13

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