Clearance for New Employees and New Volunteers
(required whenever changing an employer or supervising entity)
Organization submitting this request
*
Name of employee or volunteer
*
First Name
Last Name
Employee or volunteer's address
Street Address
*
Street Address 2
City
*
State
*
Zip
*
Employee or volunteer's address
*
Street Address
Street Address Line 2
City
State
Zip Code
Applicant is seeking clearance for employment or volunteer work? (Choose one)
*
Employment
Volunteer work
Where will the individual be employed or volunteer?
*
YOUR name
*
First Name
Last Name
YOUR title
*
Today's date
*
-
Month
-
Day
Year
Date
Email for receiving OPCY response
*
example@example.com
Postal address for hard copy
Street Address
*
Street Address 2
City
*
State
*
Zip
*
Postal Address for hard copy
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: