Background/Driving Record Investigation and Release of Information Authorization

"*" indicates required fields

Disclosure

Reason for Submission and Associated Unit

Indicate the reason for submission * Required
K Students: Select options 2 or 3 only.

Legal Information

Legal Name * Required
Address * Required
Date of birth * Required
Gender * Required

Driver's License Expiration Date
Indicate 01/01/1900 if there is no expiration date.

Criminal History

Are there any felony charges pending against you? * Required
Have you ever been convicted of a crime? * Required

Final Authorization and Signature

Clear Signature

Summary of your rights under the Fair Credit Reporting Act