Background Check
I. Personal Information
Full Name
*
First Name
Last Name
Alias (If any)
*
Previous name (If any)
*
First Name
Last Name
Present Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous Address (If any)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Birthdate
*
-
Month
-
Day
Year
Date
Place of birth
*
Citizenship
*
Sex
*
Male
Female
Civil Status
*
Single
Married
Other
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II. Employment History
Configurable list
*
III. Education History
Primary Education / Elementary School
Name of School
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year Attended
*
Secondary Education / High School
Name of School
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year Attended
College or Bachelor's degree
Name of School
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year Attended
Master's Degree (If any)
Name of School
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year Attended
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IV. Criminal History
1. Have you been apprehended, charged or convicted for a crime of violation of law?
*
Yes
No
2. Are you on probation or parole?
*
Yes
No
If the answer is Yes to any of the questions above, please provide place, date and violation details on the box:
*
V. Character References
Please list 3 references.
Configurable list
*
I hereby declare that the information submitted in this application is true and correct to the best of my knowledge. I understand that any false information will result to disqualifying this application. I hereby authorize Rooted Christian Homeschool Group and its representatives to perform an extensive review of my background based on private and public information I have provided for employment purposes. I also authorized any agencies or background check companies to perform a background check investigation as part of my application.I fully understand that this investigation will generate a report that may include personal information, education background, employment history, character references, birth records and any other records. I therefore release and hold no harm to any representatives who provides this information from any liability.
Signature
Date signed
-
Month
-
Day
Year
Date
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