Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Criminal Background & Driver Record Check Consent Form

  1. Do not shorten or use nicknames. Type your name as it is listed on your driver's license.

  2. We need your number in case we have questions regarding this form or your results.

  3. Gender*

  4. Previous Addresses (for past 7 years)

  5. Check here if you have lived at more than three addresses in the past seven years.

  6. Have you ever been arrested or convicted of a crime? *

  7. Race*

    Select one

  8. Who are you working or volunteering for?*

  9. Agreement

    Consistent with the federal Fair Credit Reporting Act, I authorize the City of East Grand Rapids to conduct an annual review of my background through an investigative consumer report and prior to performing services for the City of East Grand Rapids. I understand that the consumer report may include, but not limited to, the following: verification of my Social Security number; current and previous residences, employment history, education, references, credit, criminal history, and driving records I authorize the complete release of these records or information pertaining to me that an individual, company, firm, corporation, or public agency may have. I authorize any present or former employer or persons having knowledge of me to furnish The City of East Grand Rapids with information in connection with an application for employment, contract agreement, or volunteer application. I understand that all information submitted to the City of East Grand Rapids is considered public information and subject to disclosure under the Freedom of Information Act. I understand that pursuant to the federal Fair Credit Reporting Act, if adverse action is taken based upon the consumer report, a copy of the report and a summary of the consumer's rights will be provided.

  10. Signature*

    By checking below, I, the applicant, have read and agree to the terms and conditions listed above and have reviewed the "Summary of Rights Under the Fair Credit Reporting Act".

  11. Leave This Blank:

  12. This field is not part of the form submission.