Background Check Request Form
List any other names the individual uses or has used in the past, including married and maiden names, below. If you do not
provide every name that the individual has used, you may receive inaccurate results.
List any other city in Texas where the person has been a resident and any addresses, including county, where the person has lived outside of Texas in the previous five years.
*Must present ID that matches information given at time of Finger Printing for Employees
Contact information is required to schedule a fingerprint appointment. You must select one of the following choices and provide either an email address or phone number for the individual. Preferred method of contact for scheduling fingerprint appointment:
Please note- a $10.00 Background Check Fee is due at the time of submission
By Electronically signing this form, you are allowing Fred Moore Day Nursery School the ability to process and complete a background check using the above provided information. Your signature attests that the above information is true and correct to the best of your abilities.