Comprehensive Background Check Application
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security Number
*
Gender:
*
Please Select
Female
Male
Unknown
Race:
*
Please Select
American Indian and Alaskan Native
Asian or Pacific Islander
Black
Unknown
White(includes Mexicans and Latinos)
State of Birth
*
Height
*
Weight
*
Eye Color
*
Hair Color
*
Cell Phone Number
*
Personal Email Address
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In the past 5 years, have you resided in a US Territory, a US Tribal land, or a US State other than Georgia?
*
Please Select
Yes
No
If Yes, what state?
Put NA if this does not apply
Signature
*
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: