Background Check Form: Driver

UUCUC uses Trusted Employees to conduct their annual background screening for employees and volunteers. By submitting your information via this form, you agree that:

1. UUCUC is only using the information you provide for employment or volunteer screening purposes.
2. You are authorizing UUCUC to conduct a background screening process through Trusted Employees with the information you have provided.
3. You have read and understood the document "A Summary of Your Rights Under the FCRA."
4. You have read and understood the document: "Obligations of Users of Consumer Reports."

Do you agree with the above statements? If you do not agree or have additional questions, please contact the UUCUC Director of Congregational Administration. *

Yes
No

Would you like a copy of your report once it is processed by Trusted Employees? *

Yes
No

Applicant Information

First Name *

Middle Name *

Last Name *

Suffix

Social Security Number *

Birthdate *

Email *

Primary Phone *

Secondary Phone

Address Information

Addresses of Residence for Past Seven Years (please include full street name, apartment number if applicable, city/town, state and zip code)

Address #1 *

Address Line 1

Address Line 2

City

State

Zip Code

I have lived at this above address for seven years or more *

Yes
No

If you select no, you will be prompted to enter additional address information within the past seven years.

Please use the address fields below to provide all additional address information within the last seven years.

Address #2

Address Line 1

Address Line 2

City

State

Zip Code

Address #3

Address Line 1

Address Line 2

City

State

Zip Code

Address #4

Address Line 1

Address Line 2

City

State

Zip Code

Address #5

Address Line 1

Address Line 2

City

State

Zip Code

Address #6

Address Line 1

Address Line 2

City

State

Zip Code

Address #7

Address Line 1

Address Line 2

City

State

Zip Code

Driver's Check

It is possible that the lead minister, Religious Exploration & Engagement staff, or Director of Congregational Administration will ask for previous driver’s license numbers from other states.

Driver's License Number *

State Driver's License is Issued *

How long have you had this driver's license with the state? *

How many years have you been driving? *

Identification

Action requested: Please send a copy of your photo identification in the form of your driver’s license, passport or other state mandated photo identification to admin@uucuc.org or snail mail it to UUCUC DCA, 309 West Green Street, Urbana, Illinois 61801. Copies of IDs within email are permanently deleted after being processed. Please note, the screening process is not complete until UUCUC has a copy of a state mandated photo ID.

Electronic Signature

Please include your electronic signature below before submitting.

Please note, UUCUC removes applicant information from its web server after it is submitted, and the information provided is kept confidential and only UUCUC staff will have access to it. Copies of this application are kept in a locked, secured place at the Unitarian Universalist Church of Urbana Champaign. Only the lead minister, Director of Congregational Administration, DREE, CREE, and RE assistant have access to the locked files. Each of these persons have been vetted by the UUCUC safer congregation background check policy for employees.

UU Church of Urbana Champaign

UU Church of Urbana-Champaign

Sunday Services: 10.15am

Applicant Information

Address Information

Driver's Check

Identification

Electronic Signature