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Universal Clearance Information Form

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Richard Allen Preparatory Charter School Universal Clearance Information Form

First Name*

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Middle Name or Initial*

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Last Name*

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Social Security Number*

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Date of Birth*

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Country of Birth*

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Locality of Birth (City and State/Province/Parish/Region)*

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Current Address*

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City*

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State*

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Zip Code*

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Height*

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Weight*

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Eye Color*

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Hair Color*

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Please list all addresses where you have lived since 1975*

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Please name all of the people you have lived with since 1975. Include parents, guardians, siblings, spouses, roommates, and children.*

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Please list any previous names or aliases you have used or been known by.*

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Please read the following statement.*

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I authorize Richard Allen Preparatory Charter School to obtain background information and clearances for employment purposes.

Signature*

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Confirmation Email

Confirmation Email *

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