Shared Data Base (FSSR) Request Form

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Shared Data Base Request Form
For FDLE’s Florida Shared School Results (FSSR) System

NOTE FOR APPLICANTS WITH BACKGROUND CONCERNS: If you have ever been charged for a criminal offense for any reason, you may want to review the list of disqualifying offenses before requesting a review by Pasco County Schools. If you were charged and found guilty for any of the charges highlighted in yellow on the list, you will not be eligible to be a vendor nor work in any capacity in Pasco County Schools. Please note that your plea in a case is equally important as the outcome. If you plead "guilty" or "no contest" to any of the charges on the list, regardless of adjudication, it will have the same effect as having been found guilty for employment purposes, and you will not be eligible to be a vendor. The district may also consider frequency, recency and severity of other charges listed to make a determination of suitability to work as a vendor in Pasco County Schools.

A separate form must be submitted for each search/person requested:
Name Name First Middle Last
Are you seeking to provide services as a Charter Bus Driver?

Are you seeking to provide services as a Charter Bus Driver? No Yes
If "Yes", STOP completing this form. The form for charter bus drivers can be located here.
United States Citizen?

United States Citizen? Yes No
Under Florida Senate Bill 664, all vendors to the school district will be required to complete e-Verify for employees hired after January 1, 2021. Was or will this employee be hired by your agency prior to January 1, 2021?

Under Florida Senate Bill 664, all vendors to the school district will be required to complete e-Verify for employees hired after January 1, 2021. Was or will this employee be hired by your agency prior to January 1, 2021? Yes No
If hired on or after 1/1/2021, was a e-Verify used to determine this employee’s eligibility for employment in the United States?

If hired on or after 1/1/2021, was a e-Verify used to determine this employee’s eligibility for employment in the United States? Yes No
STOP
This employee will not be eligible for employment in Pasco County Schools unless e-Verify is completed. Employers may enroll in e-Verify at https://e-verify.uscis.gov/web/Login.aspx
Type of contact / access:

Type of contact / access: Vendor will have DIRECT contact with students or WILL have access to or control of school funds Vendor will have INDIRECT contact with students and will have NO ACCESS to or NO CONTROL of school funds Vendor will have NO STUDENT CONTACT (works off campus or when students are not present)
Social Security Number (without dashes)
*This data will be encrypted for your protection*
Date of Birth Date of Birth / MM / DD YYYY
Home Address Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email (Notifications will be sent here)
Telephone Number Telephone Number - ### - ### ####
County School District where you were Fingerprinted

If not listed in the drop-down, select OTHER at the bottom of the list and specify in the Additional Comments section below.
Additional Comments (optional)

You may provide additional information about your background screening in this section.
COMPANY OR AGENCY INFORMATION
Company/Agency Name

If you are not working with a company/agency, provide the name under which you will be doing business or providing services in Pasco County Schools.
Company/Agency Address Company/Agency Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Name of the Company/Agency Contact

The Contact is the person at the company/agency that needs to receive the information regarding the District's review of your background screening results.
Email of the Company/Agency Contact
(Copy of your notifications will be sent here)

Notifications will be sent to this email address. If you are not working with a company, please re-enter your own email address.
Telephone Number of Company/Agency Contact Telephone Number of Company/Agency Contact - ### - ### ####
Upload the Verification of Eligibility for Employment in the US (I-9 Form)

Attach Files

I-9's are issued by your employer. A copy must be submitted to the district per Florida Statute 1012.467.

Interns and other non-paid personnel are not required to upload an I-9.
NOTE: Requests can take up to 4 days for approval.

If you are having difficulty submitting the form or have any questions or concerns, you may contact us by email or telephone.

Email: screening@pasco.k12.fl.us
Phone: (727) 774-2521

Shared Data Base (FSSR) Request Form

If "Yes", STOP completing this form. The form for charter bus drivers can be located here.

COMPANY OR AGENCY INFORMATION

NOTE: Requests can take up to 4 days for approval. If you are having difficulty submitting the form or have any questions or concerns, you may contact us by email or telephone. Email: screening@pasco.k12.fl.us Phone: (727) 774-2521

NOTE: Requests can take up to 4 days for approval.

If you are having difficulty submitting the form or have any questions or concerns, you may contact us by email or telephone.

Email: screening@pasco.k12.fl.us
Phone: (727) 774-2521