Background Check Authorization (Intern)

I hereby authorize the Concho Valley Community Supervision and Corrections Department (CSCD) to investigate my background and discover any information concerning me, including information related to my reputation, education, and employment. I authorize Concho Valley CSCD to use means it determines necessary to conduct a thorough investigation including, but not limited to, a criminal history search, current and previous employment verification, personal reference contacts and/or an online information search - including a search of social networking sites (MySpace, Facebook, LinkedIn, etc.). I understand that this information will be used to assist the Concho Valley CSCD in determining my qualifications and fitness for the position for which I am applying.

I hereby release the Concho Valley Community Supervision and Corrections Department from any liability or damage which may result from the investigation or discovery of the information requested above.

Signature*

Please sign using your mouse, stylus, or finger.

Date*

Name on Driver's License*

First Last

Applicant's Phone Number*

Address on Driver's Licence*

Street Address City State ZIP Code

Is current name and/or address different than it appears on driver's license?*

Yes
No

Name if Different*

First Last

Address if Different

Street Address City State ZIP Code

Driver's License State*

Driver's License Number*

SSN*

Date of Birth*

Previous Names

Background Check Authorization (Intern)

Hours of Operation