Tarrant County Security Form

PLEASE READ: In order to be registered to serve in Tarrant County you need to perform the following actions:

Complete this form
Print out the form
Sign both pages where indicated
Send us the completed form and clear, color pictures of your Driver's License AND Social Security Card one of the two ways:
- Use the upload form here: https://behindthewalls.com/tcform
- Email Barbara Bradford at BarbaraB@behindthewalls.com

Date of Entry

Today's Date

Date

Name as it appears on Driver License*

Address*

City, State, Zip*

Telephone*

ID/Drivers License Number*

State*

Social Security Number*

Date of Birth*

Date

Place of Birth*

Email*

example@example.com

Height*

Weight*

Color Eyes*

Color Hair*

Sex*

Race*

Have you EVER been arrested as an adult or juvenile; to include a traffic ticket, dismissal, disposition, adjudication, or a walk-around bond?

YesNo

If yes within the past ten 10 years explain.*

Are you currently on or have:*

Bond/Pending ChargesProbationParoleNone of the above

Incomplete requests will not be considered. False information will result in disapproval, Information included herein will not be disclosed to third parties.

***Include a clear copy of Driver License and Social Security card when returning form for the security check ***

AGREEMENT OF ACKNOWLEDGEMENT *AUTHORIZATION* RELEASE

I state that I understand: and I hereby acknowledge that my services will be voluntarily given and that I will not be paid for work performed. Acceptance of my application in no way constitutes an offer or guarantee of regular/temporary paid employment, nor does it constitute an agreement to keep me for any specific time. I understand that volunteers are "at will" and their services are subject to discontinuance by the County at any time. I agree to let my Department know ahead of any scheduled volunteer time that I wish to discontinue my services.I also certify that all answers given by me on this application are true to the best of my knowledge. I authorize the Tarrant County employee to write or telephone my references whom I have listed on this application for the purpose of acquiring information from them, and I release Tarrant County and anyone releasing this information to Tarrant County from any liability based upon

As a volunteer, I understand that the County does not provide volunteers with employee benefits, accident insurance, death benefits, compensation for lost time due to injury; nor does the County carry general liability insurance covering volunteers.

I state that I understand: That I am being considered as a volunteer

in a Department of the Tarrant County Government. That my continued presence as a volunteer is conditional on my preservation of the confidences of this department; and that the need for confidentiality does not end when I cease to be a volunteer. I swear that I will maintain the confidences of this department and that if I have any question as to whether information is confidential, I will check with the department before disclosing such information to anyone.

Tarrant County Security Form

AGREEMENT OF CONFIDENTIALITY