Background Check & Conviction of Crime Acknowledgement Form
This document contains important information and must be read carefully and fully.
I have voluntarily applied for admission to the Medical Laboratory Science Program at Texas State University and I understand, acknowledge and agree to the following:
1. Texas State University, on behalf of the Medical Laboratory Science Program(the “Program”) will require me to obtain one or more criminal background checks("CBC").
2. The CBC will be used for evaluation of my eligibility for the Program, and eligibility for one or more clinical/practicum/internship training requirements with third party organizations.
3. The CBC will contain information concerning my criminal background, if any.
4. In all cases, all expenses associated with the CBC are my responsibility.
5. If the results of the CBC are not deemed acceptable by the Program, or if information received indicates that I have provided false or misleading statements, have omitted required information, or in any way am unable to meet the requirements for completion of the Program, my admission to the Program may be denied or rescinded, and/or I may be disciplined or dismissed.
6. I may not be admitted to a clinical setting, be permitted to test for or be granted licensure or certification if I have been or in the future am convicted of a crime.
7. Admittance to a limited-entry and/or completion of the Program in no way guarantees that I will receive licensure or certification, be permitted to practice and/or obtain future employment.
8. If, while I am a student, I am convicted of a crime of any type, other than a minor traffic violation, I must report the offense to the applicable Program manager in writing within thirty (30) days of conviction (conviction includes plea arrangements, guilty pleas, pleas of no contest, findings of guilt, etc.).
9. These background checks will be obtained by a vendor chosen and specified by the Program. The current vendor for this service is PreCheck. The vendor is subject to change at any time.
10. Background checks obtained from a vendor other than the vendor chosen and specified by the Program will not be accepted.
11. A criminal background check is not a requirement that can be waived and the information from a criminal background check may result in disqualification for participation in the program or licensure.
12. The Registrar’s Office will release copies of my transcript to the Medical Laboratory Science Program Selection Committee.
13. I am required to complete a routine physical examination including testing for Tuberculosis and immunization for Hepatitis B and other infectious diseases prior to the beginning of coursework in the program.
14. Acceptance as a Texas State University student neither equates with nor implies acceptance into the educational and professional phase of the Medical Laboratory Science Program.
15. Admission into the Medical Laboratory Science Program is determined by the Medical Laboratory Science Selection Committee.
16. I Release Texas State University, it employees, agents, officers, and regents, including but not limited to the members of the Medical Laboratory Science Selection Committee, from liability for any decision they make in reliance on any criminal background check report(s).
