New Hire Background Check Form Please complete the following form for your Licensing Background Check. Please use n/a when not applicable or you don't need to answer. Name(Required) First Middle Last Suffix Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County(Required)Social Security Number(Required)Social Security Number (Confirm)(Required)Date of Birth(Required) MM slash DD slash YYYY Sex(Required) Female Male Alternate NamesPlease enter all aliases, including maiden name if applicable. Driver's License or State Issued ID(Required)Do you have a driver's license or state issued id? Yes No Type Driver's License State Issued ID Licence or ID #State of IssueHave you lived in any other cities in Texas?(Required) Yes No If yes, please list all cities.I have lived in another state in the US in the last 5 years.(Required) Yes No If yes, enter the other states in which you have had residence within the last 5 years.Ethnicity(Required) Hispanic Not Hispanic Unable to Determine Race(Required) American Indian/Alaskan Native Asian Black Native Hawaiian/Pacific Islander White Unable to Determine T-Shirt Size(Required)All sizes are adult sizing S M L XL 2XL 3XL Method of Contact(Required)How would you like to be contacted to schedule your fingerprinting? Phone Call Email Phone for Contact(Required)Email(Required) Enter Email Confirm Email Upload copy of your IdentificationPlease take a photo of your identification and upload for verification.Max. file size: 50 MB. Upload copy of your Social Security Card or PassportPlease take a photo of your social security card or passport.Max. file size: 50 MB.
