CBC Hiring Notification Form

* Required Fields

This form is not to be submitted until the applicant has been selected, and offered conditional employment pending the sucessful completion of the background check. The applicant should be advised that they cannot start working until the background check has been succesfully completed.

Applicant Information

Last Name:*

  First Name:*       MI:

Address 1:

Address 2:


 State:   Zip:  Country:

Home Phone:

Cell Phone: 


Country of Citzenship:*

Position applied for:   

Type of Applicant*

Salary admin plan for applicant:   

Age at time of completion of this form: *

Note: If applicant is under the age of 18, then the Juvenile Criminal Background Check Consent form must be signed by a parent/guardian, and returned to Human Resources.

Completed form (if available):

Hiring Official Information

The hiring official listed will be the person who is contacted by Human Resources at the completion of the Criminal Background Check.

Hiring Official:*

Hiring Department:*



For additional comments; please use this area: