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Volunteer Background Check Authorization

Coding Club · Volunteer Screening Request

Sample form. This is a non-functional demonstration of the validated web form described in the Automating Volunteer Background Checks appendix. Nothing is transmitted, stored, or submitted to any background-check service. Do not enter a real Social Security Number or driver's license number.
1. Complete form
2. Review & e-sign
3. Submitted
Request information

These fields were filled in automatically from the volunteer registration database when you opened your secure link. If anything here is wrong, contact your activity leader before continuing.

Legal identity

Enter your name exactly as it appears on your government-issued ID. A mismatch here is the most common cause of a "record not found" result.

Optional. Leave blank if you have none.
Volunteers must be 18 or older.
Mailing address

Your current residential address.

Identification numbers
Entered directly, never emailed. These values are validated in your browser and, in the production system, are sent over an encrypted channel straight to the state background-check service. They are never photographed, emailed, stored in plaintext, or re-typed by staff.
Selecting a state applies that state's license number format.
Choose an issuing state to see the expected format.
Consent and electronic signature

Read each statement, then type your full legal name to sign.

Must match the legal first and last name you entered above.

Form incomplete

Fill in the required fields to continue.