PATIENT INFORMATION BOOKLET - Bausch + Lomb
Transcript of PATIENT INFORMATION BOOKLET - Bausch + Lomb
MEN'S AND WOMEN'S BASKETBALL
ONLINE BACKGROUND CHECK PROGRAM PROCEDURES
Access the Web site at this address:
https://web1.ncaa.org/choOfficials/exec/login
NCAA DIVISION I GAME OFFICIALS BACKGROUND CHECK PROGRAM
Welcome to the NCAA Game Officials Background Check System.
Each year, many men and women serve as officials for NCAA Division I championships and postseason
football bowl games. These championships are the Association's most high-profile events, so the
character of the officials is important. The NCAA takes very seriously it's obligation to do everything necessary to prevent gambling scandals from occurring.
For a game official to be eligible for selection to officiate an NCAA championship in the sports of baseball, men's basketball, men's ice hockey or women's basketball; or to officiate a postseason
football bowl game, the official must complete the online background check form each year. A random selection then determines which officials undergo an actual check.
The Division I men's and women's basketball officials have undergone background checks since 1999. As part of the recommendations from the NCAA Sports Wagering Task Force, beginning with the 2005-06 season, baseball and men's ice hockey officials are required to undergo background checks. The NCAA Division I Football Issues Committee recommended that background checks be required for officials working postseason football bowl games beginning in 2006.
Questions regarding the background check program can be addressed by contacting Suzanne Brickell at [email protected].
Questions regarding clinic attendance and online test scores can be addressed by contacting the following individuals:
Football and Baseball
Kim Giles [email protected]
Men's Basketball Jay Jay Rackley [email protected]
Women's Basketball
Rachel Kay [email protected]
Enter Log-in information
Last Name
Last 4 digits of Social Security Number
Submit
© 2007 NCAA
Men's and Women's Basketball
Online Background Check Procedures
Page No. 2
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1. Read the introduction page, enter your last name and last 4 digits of your social security number
and click submit.
NOTE: You must be entered in the championships officials database before you can access the
game officials background check program. Many officials are already in the database from
previous years. New officials will be entered as they attend officiating clinics. Please allow one
week after clinic attendance for your information to be entered into the database.
2. This page reflects the dates when the system will be available for officials to enter the required
background check information.
3. The left side of the screen will reflect the most recent regional officiating clinic attendance, most
recent background check forms on file, most recent sports wagering questionnaire on file and the
most recent online rules test on file.
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Online Background Check Procedures
Page No. 3
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4. Officials will be responsible for updating their personal information throughout the year. If your
address, phone number or your conference affiliations change, it is your responsibility to go into
this system and make those changes. If you make changes anytime during the year, you must click
the "save" button at the bottom of the screen.
5. Select the sport code for the sport that you officiate. If you officiate more than one sport, you must
complete the entire process for each sport (i.e. men's basketball, women's basketball, men's ice
hockey, baseball or postseason football).
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Online Background Check Procedures
Page No. 4
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6. Personal Information:
Enter you complete address, city, state and zip code.
E-mail address is optional, but we encourage you to provide that information.
Enter telephone numbers for home, work and cell.
Drivers license number is required.
The state in which your drivers license is issued is required.
Birth date is required.
Personal information:
Address: 700 W. Washington
City: IndianapolisState:
INZip code:
46206
E-mail: [email protected]
Home Phone: 317-917-6866(No spaces, dashes, etc.)
Work Phone: 317-917-6222(No spaces, dashes, etc.)
Cell Phone: 317-917-3333
Driver License Number: 753951456
State Issued: IN
Birth Date: 02/28/1955(mm/dd/yyyy)
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Page No. 5
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7. United States Citizenship (New this year).
You must indicate if you are a US citizen. If you are not a US citizen, you must send to the agent,
gambling and amateurism activities staff verification that you are legally residing within the United
States and are able to earn income as an independent contractor. This information will be verified
before an official is eligible for selection.
Note: If you are not a United States citizen, you are required to provide documentation that you are legally residing within the United States and are able to earn income as an independent contractor. This information will be verified. You must send a copy of your documentation to Rachel Newman Baker, Director of Agent, Gambling and Amateurism Activities, P.O. Box 6222, Indianapolis, Indiana 46206. In the area below, please enter the type of documentation you have that allows you to work as an independent contractor in the United States (i.e. Green Card, visa type, etc.).
US Citizen: Yes No
8. Gender and Ethnicity information is optional.
Note: Gender and Ethnicity information is optional
Gender: Male Female
Ethnicity:
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Online Background Check Procedures
Page No. 6
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9. Conference affiliation - check all that apply.
Conference affiliation (please check all that apply):
AMERICA EAST CONFERENCE
ATLANTIC 10 CONFERENCE
ATLANTIC COAST CONFERENCE
ATLANTIC SUN CONFERENCE
BIG 12 CONFERENCE
BIG EAST CONFERENCE
BIG SKY CONFERENCE
BIG SOUTH CONFERENCE
BIG TEN CONFERENCE
BIG WEST CONFERENCE
COLONIAL ATHLETIC ASSOCIA
CONFERENCE USA
HORIZON LEAGUE
INDEPENDENT
IVY GROUP
METRO ATLANTIC ATHLETIC C
MID-AMERICAN CONFERENCE
MID-EASTERN ATHLETIC CONF
MISSOURI VALLEY CONFERENC
MOUNTAIN WEST
NORTHEAST CONFERENCE
OHIO VALLEY CONFERENCE
PACIFIC-10 CONFERENCE
PATRIOT LEAGUE, THE
SOUTHEASTERN CONFERENCE
SOUTHERN CONFERENCE
SOUTHLAND CONFERENCE
SOUTHWESTERN ATHLETIC CON
SUMMIT
SUN BELT
WEST COAST CONFERENCE
WESTERN ATHLETIC CONFEREN
10. Click "Go" to proceed to the next step.
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Online Background Check Procedures
Page No. 7
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11. General Policies. You must read this page and check the box at the bottom that you agree to the
terms and conditions that are specified in the general policies.
12. At the bottom of the General Policies page are links to other documents that are helpful in
understanding the NCAA Game Officials Background Check Program.
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Online Background Check Procedures
Page No. 8
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13. NCAA Position on Sports Wagering. This document appears as a word document; close the
document to return to General Policies page.
14. Frequently Asked Questions. Helpful questions and answers about the NCAA Game Officials
Background Check Program. This document appears as a word document; close the document to
return to the General Policies page.
Men's and Women's Basketball
Online Background Check Procedures
Page No. 9
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15. Click Background Check Form to begin completing the necessary documentation.
16. Authorization and Release of Custodial Information. You must read and check the box that you
have read the release, understand it and agree to the terms and conditions therein.
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Page No. 10
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17. The information that appears on your log-in page (name, address, etc.) will automatically appear on
the bottom portion of this page. Click Personal Background Questionnaire.
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Page No. 11
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18. Other names. List any other names you may be known by, including maiden name, and dates
names were used.
19. Address. List all address where you have resided during the past seven years. The dates that you
lived at each address are also required.
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Page No. 12
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20. Employer Information. Enter employer name, department in which you work, phone number,
address, city, state and zip. You must also provide an explanation of your duties.
21. If you are self-employed or hold 10 percent ownership or more of the business that employs you,
you must provide an explanation.
22. If you have ever been convicted of a violation of law, or have been charged with a crime that is
awaiting adjudication, you must provide an explanation.
23. If you have claimed bankruptcy, or been the subject of a collection account, or the subject of a lien,
suit or judgment, you must provide an explanation.
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24. Click "sports wagering questionnaire" to proceed to next portion.
25. Answer each question with "yes" or "no." A "yes" answer requires an explanation. After
completing the questionnaire click submit.
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Page No. 14
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NOTE: By clicking submit, you are certifying that all of the information furnished on the questionnaire is
true, complete and correct. After you click submit, you will not be able to access the forms again. So be
sure your answers are accurate before submitting.
26. After submitting, print a copy of your forms for your records. Your printed copy will reflect the
date that you submitted your forms.
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Online Background Check Procedures
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27. If you go back into the system after you have submitted the information, you will receive a message
that your background check questionnaire was already submitted. You can print a copy, but will
not be able to access the information.
NCAA DIVISION I GAME OFFICIALS
BACKGROUND CHECK PROGRAM
Background check questionnaire was already submitted on August 30,
2007.
The National Collegiate Athletic Association
September 4, 2007 esb