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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.

   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

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