Webb City Youth Cheerleading | Background Check for Coaches

Background Check for Coaches

Coach's Full Name*
First Middle Last Suffix
Maiden Name
Date of Birth*
MM slash DD slash YYYY
State of Birth*
State
Gender*
Race/Ethnicity*
Alias Name(s)
Driver's License Number*
Driver's License State*
State
Addresses for the Last Five Years
Current Address*
Street Address Address Line 2 City State ZIP Code
Previous Address
Street Address Address Line 2 City State ZIP Code
Previous Address
Street Address Address Line 2 City State ZIP Code
Previous Address
Street Address Address Line 2 City State ZIP Code
Have you ever been found guilty or been convicted of any criminal act in this state or any state?*
- No. I have not been found guilty or been convicted of any criminal act in this state or any state.
- Yes (Complete section below)
Date*
MM slash DD slash YYYY
City*
State*
State
County*
Circumstances*
Have you ever been substantiated as a perpetrator in any child abuse or neglect report made to the Children's Division in this state or any state?*
- No. I have not been substantiated as a perpetrator in any child abuse or neglect report
- Yes (Complete section below)
Date*
MM slash DD slash YYYY
City*
State*
State
County*
Circumstances*
The information provided is complete and accurate to the best of my knowledge. I understand it is unlawful to withhold or falsify the information required on this form. I grant permission to Webb City Youth Cheer to obtain any and all information needed to process my request and to use the information as permitted by law.
Signature of Applicant*
Date of Application*
MM slash DD slash YYYY

Background Check for Coaches

Addresses for the Last Five Years