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BACKGROUND CHECK FORM
By filling out this form, you are allowing HYAA to conduct a background check utilizing the truthful information you are providing below. This information will only be used for purposes of completing the background check and any information provided to and returned from our background check company is considered private and confidential. The HYAA organization requires that background checks be conducted every three years.
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* Indicates required question
Full Legal Name (First, Middle, Last)
Your answer
Former Name (First, Middle, Last)
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Current Address Since: (Date, Street, City, State, Zip)
Your answer
Previous Address From: (Date, Street, City, State, Zip)
Your answer
Previous Address From (Date, Street, City, State, Zip)
Your answer
Social Security Number (this is a secure form)
*
Your answer
Current Telephone Number
Your answer
Type Name and Date to give HYAA permission to submit information to Protect Youth Sports
Your answer
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