Background Check Form

We are ready to have you work/volunteer at the Rochester Hills Public Library, but before we do that we need to do a background check on you. To do that check, we need the following agreement and information from you. If you are under the age of 18, a background check is not required.
I agree to allow the Rochester Hills Public Library to do a background check on me, which may include a criminal background check, a credit check and a check of my driving record.

I agree to allow the Rochester Hills Public Library to do a background check on me, which may include a criminal background check, a credit check and a check of my driving record. I agree.
Department applying for:
My legal name is: My legal name is: First Middle Last
Any other known name used: Any other known name used: First Middle Last
My date of birth is: My date of birth is: / MM / DD YYYY
My race is:

My race is: White Black Asian or Pacific Islander American Indian or Alaskan Native Unknown/Other
My gender assigned at birth:

My gender assigned at birth: Male Female Unknown
My current mailing address: My current mailing address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
My current email address:
Candidate's Signature:

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY