BELTON INDEPENDENT SCHOOL DISTRICT

BELTON INDEPENDENT SCHOOL DISTRICT

2 Pages · 2012 · 28 KB · English

DPS Computerized Criminal History (CCH) Verification (AGENCY COPY) I, , have been notified that a Computerized Criminal APPLICANT or EMPLOYEE NAME (Please print)

BELTON INDEPENDENT SCHOOL DISTRICT free download


BELTON INDEPENDENT SCHOOL DISTRICT CRIMINAL HISTORY RECORD INFORMATION ADDENDUM Confidential* The Belton Independent School District is required by Texas Education Code Chapter 22, Subchapter C to review the criminal history of applicants, employees, independent contractors, student teachers, and certain volunteers. The information requested below is necessary to obtain criminal history record information. PLEASE PRINT. Full Name_____________________________________________________________________ Last First Middle Maiden/Other Social Security Number _____________________ Date of Birth: _______/_______/_______ Month Date Year Driver’s License _____________________________________ State and Number Mailing Address _______________________________________________________________ Street City State Zip Sex: Male Ethnicity: Black Female White/Other Position applied for: __________________________________________________________ I understand that the information I am providing about age, sex, and ethnicity will not be used to determine eligibility for employment but will be used solely for the purpose of obtaining criminal history record information. Signature: _____________________________________________________ Date: ___________________________________ * This form will be removed from the application and filed separately in

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