2011-2012 REQUEST FOR FINGERPRINTING OF CHARTER SCHOOL EMPLOYEES
This form will only be accepted if it is submitted electronically to: SESFINGERPRINTING@dadeschools.net.
Changes/modifications to this form are strictly prohibited and will be considered a violation of the SES contract.
Incomplete and/or altered Appendix F-1 will not be processed.
Pursuant to Section II. U. of the 2011-2012 SES Contractual Agreement: "The Provider agrees that as a condition of entering
into this Contract, it will ensure that all staff members, including any administrative personnel who may have contact with
students or visit school facilities while students are present, have undergone background checks with the Florida Department
of Law Enforcement. The Provider further agrees that any person representing their organization entering school grounds or
having direct contact with students shall meet Level 2 screening requirements as described in §1012.32, Florida Statutes."
Our agency understands that no staff member will be allowed to work directly with students until their name appears
on "the most current SES Provider tutor Clearance Report".
SES Provider Name:
SES Provider Code:
CHARTER SCHOOL EMPLOYEE
Date of Birth District Office
LAST NAME FIRST NAME Employee # (MM/DD/YYYY) Social Security # Use Only
* Mark for all "Resubmittals". Please do not send a new form.