Background Check Application - Warren County Kentucky

Date of Application

Position Desired*

League (Check all that apply)*

Name

First NameLast Name

Date of Birth

Drivers License Number

State

Sex*

Last 4 Digits of Social Security Number*

Email*

Phone*

Do You Receive Text Messages?

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current Employer

Employer Phone

Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Have you ever been arrested, charged, or convicted of a crime?*

If yes, explain in detail:

Have you ever been involved in an incident involving child abuse or neglect?*

If yes, explain in detail:

Have you ever had a problem with alcohol or drugs?*

If yes, explain in detail:

By electronically signing this application below, I grant WCPRD and the League for which I am applying the permission to run a criminal background check.

I verify that I have read the WCPRD Applicant Background Check Guidelines in the page above.*

I verify that I have read the WCPRD Background Check Application Notice in the page above.*

Please read the Warren County Code of Ethics

I verify that I have read the WCPRD Code of Ethics (above), and I understand that cursing, pushing, hitting, threatening, alcohol consumption, or disorderly conduct is NOT allowed on WCPRD properties or properties where WCPRD events are being held.*

I verify that I have read the WCPRD Sportsmanship Policy.*

E-Signature (draw with your mouse or touch screen)

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