Staff Criminal Background Check Staff Criminal Background Check The following applicant has applied for employment at Camp Coyote in Huntsville, Texas. We would like to have his/her criminal record checked. We would like you to pay special attention to the offenses of Child Abuse, Drug Use, DWI, and any violent crimes. First Name*Middle Name (if none, enter 0000)*Last Name*Date of Birth* Social Security Number (XXX-XX-XXXX)*Street Address*City*State*Zip Code*County*Place of Birth (City & State)*Driver's License Number*Driver's License State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificI have applied for employment with Camp Coyote in Huntsville, Texas. I fully understand that I must have my criminal background checked before I can accept a position with Camp Coyote. I hereby give my permission to have my background investigated by whatever means deemed necessary by Camp Coyote. I further understand that all background information will be confidential. I understand that Camp Coyote has the final discretion in hiring me based on my background check results. I have read and agree to the Agreement & Certification above.* Agree My typed name is intended to be my electronic signature. I am applying my digital signature below to indicate my agreement with the preceding statements.Digital Signature*Date of Submission* Time of Submission* : HH MM AM PM This iframe contains the logic required to handle Ajax powered Gravity Forms.