Criminal Background Check Policy printable pdf download

Criminal Background Check Policy

Parks & Community Services Department

Criminal Background Check Policy

Type

Temp/Intern

Park Instructor/Contractor

Volunteer

Staff requesting search:

Program area:

Please print all information:

Name:

(First)

(Middle)

(Last)

(Maiden)

Gender:

Male

Female Race:

Asian

Black

Caucasian

Hispanic:

Multi

Social Security Number:

Date of Birth:

(Month)

(Day)

(Year)

Driver’s License:

(State)

(Number)

(Expiration date)

Email address:

(Background search results will be electronically sent to you – please print clearly)

Current Address:

(Street)

(City)

(State)

(Zip)

(Years living here)

Phone:

(Home)

(Cell)

(Business)

(Fax)

Previous Addresses: Last 10 years.

(Street)

(City)

(State)

(Zip)

(Years living here)

(Street)

(City)

(State)

(Zip)

(Years living here)

Certification: I hereby certify that all statements on the attached background check form are true, complete, and

correct to the best of my knowledge and belief. I understand that the City of Bellevue solicits this information and

may solicit additional information so as to be informed of my previous record and character. I further understand

and agree that any misrepresentation, falsification, or omission of facts by me may result in my disqualification

from City for volunteering and employment or an adverse employment action, up to and including my release or

dismissal from City Employment.



Signature

Date



Parent/Guardian Signature (for applicants under age 18)

Date

Criminal Background Check Policy

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