YWCA Request for Background Check
Background request form
First Name: *
Middle Name: *
Last Name: *
List any other names you may have used in the past: *
Street Address: *
City: *
State: *
Zip Code: *
County: *
Telephone Number: *
Date of Birth: *
MM
/
DD
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YYYY
Gender: *
List any other city in Texas where you have been a resident of, include address and county: *
List any of City, State and address what you have been a resident of within the past 5 years:
Ethnicity: *
Race: *
Social Security Number *
Photo ID Type: *
Photo ID Number *
Photo ID State: *
Best method of contact to schedule fingerprint appointment. List your email address or phone number. *
YWCA of Lubbock conducts background checks through the TH&HS Child Care Licensing program after a conditional offer of employment has been made. The TH&HS department will contact you with background results by email/mail, the YWCA will require a copy of that report. Criminal background checks may not be used as the sole reason for denying employment unless it is job related. Regardless the company has the right to make a final decision about employing an individual after the background check is complete. By submitting this form you give the YWCA of Lubbock consent to run your background. *
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