Category CCriminal Background Check

CBC Category C
Other/Affiliate No Signature Required - (DPS Public Site)

Complete the information below, then press the SUBMIT Email button. All fields are required!

EMPLOYEE INFORMATION

Last Name: Birth Date:  
First Name: Employee Contact
Phone Number:     
Middle Name (if no middle name, enter "NONE"):  
Other Names Used (if no other names, enter "NONE"): Position Title:

HRMS ASSIGNMENT (check all that apply)

 
 
 

VERIFICATION

  Verify applicant information with a STATE or FEDERAL Picture ID
  Verification Document: If Other, please specify:
  Verification Number:     

DEPARTMENT INFORMATION

  VP Office:
  Department: Billing Account Number:
  Supervisor:
  Supervisor Phone:

PREPARER'S INFORMATION

  This information was verified by:
  Full Name:
  Phone Number:
  Email Address:  
  Press the Submit Email button below when completed.