Rattan Public Schools

Background Check Information Form

(Printable Form)

Send to:

Bruce Lawless

 Superintendent of Schools

PO Box 44

Rattan, OK 74562

Name
	(Last)                                    (First)                                (Middle)                    (Suffix)
Other Names
	(Maiden)                      (Nick name or other name)                           (Mothers Maiden Name)
Current Address:
	(Number and Street)                (City)                    (State)          (Zip Code)                 (Phone)                (Alt. Phone)
Drivers License & SSN
	( DL #)                                (State)                               (Social Security Number)
Appearance
	(Height)               (Weight)                 (Hair Color)                 (Eye Color)
Personal Information
	(Date of Birth)         (Sex)              (Race- American Indian, African American, Asian, Hispanic, Caucasian, Other)
Department or Position For Which you  are Applying

By signing below I agree to the employer’s use of any information provided during the application process in performing the criminal history check.  I understand that I have the right to review and challenge any negative information that would impact my application or employment status.  I understand I that I would have a reasonable opportunity to clear up any mistaken information reported within a reasonable time frame established within the sole discretion of the Rattan School Administration.  By submitting this form I agree that all information is true, correct and complete.  I understand that any information that proves to be incorrect or incomplete would be grounds for canceling my employment applicant status and may be used at the discretion of Rattan Public School District.

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                         Signature                                                    Date