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Background Check

indicates a required answer

A background check is required of all instructors at Crown Homeschool Community. Please fill out the form for your background check submission.

1. *

Do you voluntarily consent to this background check?

 (1 required)
Yes No
2. *

Name on Driver's License:

3. *

Driver’s License #:

4. *

State Issued:

5. *

Name on Social Security Card:

6. *

Social Security #:

7. *

Have you ever been convicted of any felony?

 (1 required)
Yes No
8. *

Have you ever been convicted of any misdemeanor?

 (1 required)
Yes No
9. *

Do you currently have any felony or misedemeanor charges pending against you?

 (1 required)
Yes No
10. 

If yes (to any of these), please explain:

11. *

Date of Birth ( mm / dd / yyyy  ):

12. *

Current Address:

13. *

Phone Number:

14. *

Email Address:

15. *

By typing your full name and today's date in this box, you are indicating your consent to a criminal background check.