Campus Mail Services

Need Help?
Call (831) 459-2764
campusmail@ucsc.edu
Fax (831) 502-7190

Campus Mail Services
UC Santa Cruz
1156 High Street
Santa Cruz, CA 95064-1077

 


LiveScan Home | Applicant | Hiring Unit

LiveScan Service Request
for Applicants

Please complete all fields of this form and click the 'Submit' button. Please make sure all information has been entered in correctly before clicking 'Submit'.

In addition to this form, your Manager or Supervisor also needs to fill out a Hiring Unit Live Scan Service Request for you. Once both forms have been processed, we will email you to come in to be fingerprinted.

All inquiries should be directed to Marcia Buenafe at (831) 459-2764 or you can email campusmail@ucsc.edu.



Name of Applicant: Last
First MI
AKA's: Last
First MI
Date of Birth:
Place of Birth:
Gender:
Male Female
Hair Color:
Eye Color:
Height:
Weight:
Home Address
 
Street:
City:
State: Zip Code:
 
Have you resided in a state other than California in the last ten years?
 
Yes No
States Resided in (other than California) over the last ten years:
 
Email:
Home Phone:
Hiring Unit:
Manager or Supervisor:
Applicant's Job Title:
Do you plan to get fingerprinted on Campus? (default is 'yes')- Yes No

PRIVACY NOTIFICATION

The State of California Information Practices Act of 1977, effective July 1, 1978, requires the University to provide the following information to individuals who are asked to supply information about themselves.

The principal purpose for requesting the information on this form is for conducting job-related background investigations on persons filling critical positions. University policy authorizes the maintenance of this information.

Furnishing all information on this form is mandatory. Failure to provide the information may delay or prevent completion of the action for which the form is being filled out. Information furnished on this form may be used by the University for personnel administration and will be transmitted to the Federal and State governments as required by law.

Individuals have the right to review and to request amendment to their own records. Information can be obtained from campus or system wide staff Human Resources Offices.

The official responsible for maintaining the information contained on this form is UCSC Staff Human Resources.

NOTIFICATION OF SUBSEQUENT CONVICTIONS:

If an employee/volunteer in a critical position requiring a background investigation is subsequently convicted of a crime, they must immediately report the conviction to his/her direct supervisor. Failure to provide notification of a subsequent conviction may be sufficient reason to take disciplinary action up to and including dismissal.




 

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