This form must be completed, signed and printed legible. (PLEASE PROVIDE A COPY OF YOUR STATE ID OR DRIVER LICENSE)
NOTE: All background checks may take up to 30 days to be completed.
If the criminal background check results are to be released to a third party, you must provide the third-party name and mailing address in blocks 11, 12, 13, 14 & 15.
If the criminal background check results are to be faxed, you must provide a fax number in block 16.