Background Check

Team/Organization Name: *

Name *

First

Last

List any other names previously used (includes Maiden Name)

Date of Birth:

Address

Address Line 1

Address Line 2

City

State

Zip Code

1. Have you ever been convicted of a sex-related crime?

a. If yes, did the crime involve force or minors?

2. Have you ever been convicted of a crime involving violence or threat of violence?

3. Have you ever been convicted any other crime (including traffic crimes) except a minor traffic violation?

5. Have you ever been arrested within the last three years for a crime for which there has not yet been an acquittal or dismissal?

Minor Applicants (under the age of 18):

Electronic Signature of Parent/Guardian

Applicant 18 years or older:

Electronic Signature

Background Check/Criminal History Verification