Applicant Disclosure and Authorization Form

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Authorization for Norris School District to conduct background investigation.

First Name *

Legal Name (Example: Thomas instead of Tom.)

Last Name *

Email Address *

(Required by law so we can inform you if any derogatory information is uncovered in your background check report.)

Social Security Number (9 digits) *

BirthDate (MM/DD/YYYY) *

YYYY

Address *

City *

State (2 Letter Abbreviation) *

Zip Code *

Driver's License Number (Not required)

DMV License Number

Purpose for background check. *

By checking the box below, I have read the Applicant Disclosure Form and Acknowledgment, and authorize Norris School District to complete a background investigation. *

NOTE - Disclosure form available in the Central Office or can be viewed here: https://bit.ly/NorrisBGauth

I authorize

Required

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