Background Check Renewal

Name*

Email*

Mobile Phone*( ) -

Work Phone Number( ) -

Current Address*

Years at this address*

Previous Address (If you have been at your current address for less than 5 years)

Occupation

Employer

Work Status*

Martial Status*

In the past two (2) years have you used illegal drugs or abused perception drugs?*

Yes

In the past two (2) years have you gone through treatment for alcohol or drug abuse?*

Yes

In the past two (2) years have you been arrested, charged or convicted of a crime?*

Yes

Have you ever been accused or convicted of child abuse, sexual abuse or domestic violence?*

Yes

If you answered yes to any of the above, please describe.

BACKGROUND CHECK

For the safety and protection of our families, we require every person serving in a leadership position to submit to a criminal background check. Please provide the following information to complete this process.

Date of Birth*

Social Security No.*

Maiden Name:

Signature

I affirm that, to the best of my knowledge, the information on this application is correct. I authorize any reference listed on this application to supply information that may impact my service at Oakhill. By initialing, I also give permission to do a criminal background check.

Initial:*

Date*

Please leave this field blank.