Partnership Background Check

Examples of Duties

Per City policy, we are required to run an annual background check on our seasonal employees. The employees of the following positions are requested to complete this application with the information needed for the background. Those positions are: Dance Instructor, Dance Assistant Instructor, Recreation Instructor II & III, and Fitness Instructor.

This position is a non-benefited position with the City of Appleton.

01

For purposes of conducting a background, please list your legal name (first, middle initial, last) and any former names (maiden, etc.)

02

For purposes of conducting a background check, please list your birth date (month/day/year).

03

For purposes of conducting a background check, please list your driver's license number. If you do not have a driver's license, please list N/A.

04

For purposes of conducting a background check, please list any previous addresses you have had in the last 5 years.

05

If any former addresses have been OUT OF STATE, please list your SOCIAL SECURITY NUMBER. If not applicable, please type N/A.

06

I certify that all information I have provided is correct. I understand that falsification of information, or omissions from this application may result in disqualification or removal from a volunteer position. I understand that the information provided will be used to conduct a criminal background check.

• Yes
• No
• Required Question