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Criminal Background Check Authorization

2. Authorization for Release of Information
   I have applied for a volunteer position with the City of Burnsville. As part of the evaluation of my suitability for volunteering in this position, a background investigation is to be conducted. I authorize the Burnsville Police Department to conduct the background check in the following areas: Criminal History Check, Local Police Record Check, Warrant Checks, Driver’s License Check, and Historical Address Check.
4. Contact Information
6. First Name (Full)*
7. Last Name (Full)*
8. Middle Name (Full)*
10. Maiden Name (if applicable)
11. Race*
    -- Select One --American Indian or Alaskan NativeAsian or Pacific IslanderBlackWhite
12. Sex*
    -- Select One --MaleFemale
14. Date of Birth*
15. Driver's License #*
16. State of Issue *
18. Address1*
20. Address2
22. City*
23. State*
24. Zip*
26. Volunteer Position Applied For:*
    -- Select One --BCTV Remote EventsBCTV Studio AdministrationBuckthorn RemovalFire Department AnalystInterpreter/TranslatorMobile Volunteer NetworkOptical Imaging/Inspection SchedulingPark Pet PatrolGeneral
28. List Prior Places of Residence (COMPLETE ADDRESS AND DATES) for past ten years*
30. Photo ID Color Copy/Scan
    FOR APPLICANTS 18+: Please upload a color copy of your Driver's License/Photo ID. This is required to complete the background check.
31. If you have problems uploading or are unable to upload a color copy of your photo ID, call 952-895-4575.
33. By checking "Yes," I agree to allow the Burnsville Police Department to run a Criminal Background Check on me for the purposes of determining my suitability for this program. I hereby acknowledge that I have completed the above information fully and accurately.*

    1. YES
35. 
    
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field