Kids Unlimited of Oregon Authorization for Background Check Form

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CANDIDATES ARE ONLY REQUIRED TO COMPLETE THIS FORM AFTER YOU HAVE ACCEPTED AN EMPLOYMENT OFFER. VOLUNTEERS ARE REQUIRED TO COMPLETE THIS FORM PRIOR TO VOLUNTEERING IN KU FACILITIES. ALL INFORMATION MUST BE COMPLETED FOR REQUIRED FIELDS. TYPING YOUR NAME IN THE LAST FIELD AND CLICKING SUBMIT INDICATES YOUR AUTHORIZATION FOR KIDS UNLIMITED TO PERFORM A BACKGROUND INVESTIGATION.

Email *

Which of the following best describes you? *

Applicant/Candidate ( I have been offered employment with Kids Unlimited and have accepted the employment offer)

Volunteer (I wish to volunteer with Kids Unlimited)

Other:

Name (Last), (First), (Middle) *

List Other Names Previously Used (Maiden Name)

Current Address (Street, City, State, Zip) *

Previous Address (Street, City, State, Zip)

Date of Birth *

YYYY

Social Security Number (This is required for background check purposes) *

Have you ever been convicted of a sex related crime? *

Yes

Other:

Have you ever been convicted of a crime involving violence of threat of violence? *

Yes

Other:

Have you ever been convicted of a crime involving criminal activity in drugs or alcoholic beverages? *

Yes

Other:

Have you been convicted of any other crime except minor traffic violations? *

Yes

Other:

Have you ever been arrested within the past three years for a crime for which there has not yet been an acquittal or dismissal? *

Yes

Other:

If you have answered "Yes" to any of the previous questions on the background check, please give us additional information regarding these events. (Type of Conviction, Date of Conviction, and Convicting Agency)

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