[AGENCY NAME] field: Every place the field is present; the name of the agency providing the determination will be inserted. (L Name, F Name Middle Initial): Is the name of the individual being assigned to the agency. (Contact Number): Is the phone number of the individual being assigned, in case of follow-up. (Position Assigned): Is the your agency is assigning the individual too, that prompted you to “position” request a fingerprint background check. Only one determination is selected, either: indicating the individual does not have a offense” that, by law, would prohibit them from “Yes,” “listed working and you are accepting him or her for assignment. indicating while the individual does not have a offense” that, by law, would prohibit them “Yes,” “listed from working, your agency is choosing to not accept the individual for assignment. indicating the individual did not meet the requirements per state law in order to clear the individual “No,” for work. Note: this selection should not be chosen if an individual has passed the background check but the NCJA is choosing not to accept him or her. Printed Name & Title: Is the name and title of the NCJA employee authorized to make an assignment determination on behalf of the agency. Signature: Is the signature of the NCJA employee provided in Name & Title.” “Printed Is the date the individual was approved for assignment with your agency. Approval Date: [AGENCY NAME] DETERMINATION FOR ASSIGNMENT (L Name, F Name Middle Initial) (Contact Number) (Position Assigned)
[AGENCY NAME] field: Every place the field is present; the name of the agency providing the determination will be inserted. (L Name, F Name Middle Initial): Is the name of the individual being assigned to the agency. (Contact Number): Is the phone number of the individual being assigned, in case of follow-up. (Position Assigned): Is the “position” your agency is assigning the individual too, that prompted you to request a fingerprint background check. Only one determination is selected, either: “Yes,” indicating the individual does not have a “listed offense” that, by law, would prohibit them from working and you are accepting him or her for assignment. “Yes,” indicating while the individual does not have a “listed offense” that, by law, would prohibit them from working, your agency is choosing to not accept the individual for assignment. “No,” indicating the individual did not meet the requirements per state law in order to clear the individual for work. Note: this selection should not be chosen if an individual has passed the background check but the NCJA is choosing not to accept him or her. Printed Name & Title: Is the name and title of the NCJA employee authorized to make an assignment determination on behalf of the agency. Signature: Is the signature of the NCJA employee provided in “Printed Name & Title.” Approval Date: Is the date the individual was approved for assignment with your agency. [AGENCY NAME] DETERMINATION FOR ASSIGNMENT (L Name, F Name Middle Initial) (Contact Number) (Position Assigned)
Determination_for_Assignment_and_Instructions_462273_7.docx