Background Check Department Request Form
Background Check Department Request Form
Applicant Name
Applicant Name
*
First
Last
Applicant Email
*
Job Number
*
Job Title
*
Department Name
*
VC Area
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Chancellor
Academic Affairs
Research Affairs
Equity, Diversity and Inclusion
Student Affairs
Marine Sciences
CFO & Health Sciences CFO
Advancement
Resource Management & Planning
Project/Task Numbers (add Funding Source if Sponsored Research)
*
Hiring Supervisor
Hiring Supervisor
*
First
Last
Hiring Supervisor Email
*
Hiring Supervisor Phone
Hiring Supervisor Phone
*
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Services Requested
*
Services Requested
Live Scan Fingerprint Background Check DOJ/FBI (includes Sex Offender Registries)
Consumer Report Background Check: SSN Trace, Federal and County Criminal Records Checks, Sex Offender Registries
(for out-of-state applicants only)
Driving Record and Valid Driver License Verification
Additional Information
Email address to send confirmation to:
*
Report Results To:
Name
Name
*
First
Last
Email
*
Phone
Phone
*
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