Background Check Form

REQUIRES LEGIBLE COPY OF GOVERNMENT ISSUED ID
Full Legal Name*

First NameMiddle NameLast NameSuffix
Social Security*
Date of Birth*

MonthDayYear
Date
State-Issued Driver's License or Identification #*
State issued in*
Male or Female
Height*
Please enter height in feet and inches
Weight*
Please enter weight in pounds
Hair Color*
Address*

Address

Street Address Line 2

CityState

ZipCode
County
Phone #*
Are you a US citizen?*

YesNo
Place of Birth*
Other Cities of Residence in Texas in the Last 5 Years:
Out of State Addresses in the Last Five Years:
Ethnicity*

HispanicNon-Hispanic
Race:*

American Indian/Native AmericanAsianBlackHawaiian/Pacific IslanderWhiteUnable to determine
Alternative Names: (such as maiden name):
First Name
Middle Name
Last Name
Alternative Names: (such as maiden name):
First Name
Middle Name
Last Name
Have you ever been convicted of a crime, including but not limited to instances where you received deferred adjudication, pled guilty, or pled no contest?*

YesNo
If yes date

MonthDayYear
Date
Please Upload a copy of your Government Issued ID*

Cancelof
I authorize the Crisis Center of Comal County, to submit my identifing information to the appropriate authorities in order to conduct a criminal and abuse/neglect background check on me for either employment/intern/volunteer purposes.
Signature
*
Date*

MonthDayYear
Date
Email*
example@example.com
Should be Empty: