Plainfield Community School Corporation

Welcome to the approval process.

This registration process includes:

Information Collection
Background Check Authorization

Please click the 'Next Step' button to start the process

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I agree to the terms above and have completed any necessary steps listed above*

ENTER YOUR INFORMATION

First Name*

Last Name*

Email*

Birthdate*

Street Address*

Apt or #*

City*

State*

Zip Code*

Phone Number*

Social Security Number*

Drivers License Number*

Drivers License State*

In order to complete your background check, please provide any and all Professional Licenses so that we may verify your credentials

License Number	License Type	Issuing Agency	State Issued
{{license.licenseNumber}}	{{license.licenseType}}	{{license.agency}}	{{license.stateIssued}}
Please provide at least one professional license.
If you have applied for a license, but not yet been approved, please use "Pending" as the License Number.

has Licenses*

Additional notes*

Have you ever been convicted, plead guilty or no contest before a court for any federal, state or municipal criminal offense, such as a misdemeanor/felony, regardless of the age of conviction? Please include any felony/misdemeanor driving offenses such as Driving While Suspended, DWI(Driving Under the Influence) or OWI(Operating a Vehicle Under the Influence). Traffic infractions (ie speeding or parking tickets) are not required for disclosure.*

Please provide the details (state, county, date and details of conviction).*

Have you ever received probation or community supervision for any federal, state or municipal criminal offense?*

Please provide the details (state, county, date and details of conviction).*

Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States?*

Please provide the details (city, country, date and details of conviction).*

Do you currently have any pending charges against you?*

Please provide the details (state, county, date and details of conviction).*

AUTHORIZATION

I agree to the terms of this agreement*

My signature*

For Organization Use Only

Payment Information

By clicking "Submit", I am authorizing Safe Hiring Solutions to charge my credit card the total amount of {{(vm.registration.cost) | currency}} to order the background check on {{vm.registration.firstname}} {{vm.registration.lastname}}. Additional fees may apply in order to complete the background screening process.

Credit Card - Visa, MasterCard and Discover Only*

CCV*

Expiration Month*

Expiration Year*

REQUEST SUCCESSFULLY SUBMITTED

Plainfield Community School Corporation

Welcome to the approval process.

This registration process includes:

Please click the 'Next Step' button to start the process

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DISCLOSURE REGARDING BACKGROUND INVESTIGATION

ENTER YOUR INFORMATION

AUTHORIZATION

Payment Information

REQUEST SUCCESSFULLY SUBMITTED