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Background Information Form
Role Models University
» Background Information Form
Download
Download our Background Application
Please complete this form if you would like to volunteer directly with our students and/or become a member of our University staff. There is a $25 non-refundable fee that must be submitted with the Background Information Form.
As per the laws of the state of North Carolina we are required to complete a background check of all volunteer persons working youth.
Full Name
*
Please enter your first, middle and surname.
Other Names Used – Maiden Names – Dates Used
Current Address
*
City, State Zip
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Phone
Email
Previous Addresses
Please list any previous addresses used in the last 7 years along with the dates of residence.
Address One
Address Two
Address Three
Address Four
Other Information
Date of Birth
*
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DD
YYYY
Driver's License #
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State Issued
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May we contact your current employer?
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Have you ever been convicted of a crime?
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