Prototype - Utah Background Screening Application- Adult

Utah Background Screening Application- Adult

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
Select role*

Step 1- EmployeeI need to print a form
Click the print icon in the top right corner to print

Utah Background Screening Application- Adult

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
Consent and privacy statement
Employee Legal Name*

Legal First NameLegal Middle Name (Use N/A if no middle name)Legal Last Name
Maiden, Alias, & Previous Married Names, if this does not apply type NA*
Write NA if none
Employee Phone Number
Please enter a valid phone number.
Employee Email Address*
example@example.com
Employee Date of Birth*

MonthDayYear
Date
Employee Social Security Number*
Employee Address*

Street Address

Apartment or Unit Number

CityState

Zip Code
Employee Address State Abbreviation
In the last five(5) years, have you lived in or have you spent six(6) or more consecutive years in a U.S. state besides Utah?*

YesNo

Submit a copy of your social security card and current driver license, state identification card, passport, or military ID for verification of identity and the following information.*

Cancelof
Valid identification type*

Driver LicensePassportState IDMilitary ID
State or Country Issued*
ID Number*
Date of Expiration*

MonthDayYear
Date
Gender*
Race*

AsianBlackWhiteNative AmericanHispanic
Eye Color*
Hair Color*
Height in feet and inches*
Weight*
Place of birth (City, State)*
City, State
Authorization must be given to the Utah Department of Health and Human Services Office of Background Processingto complete the background check. This will come in an email from noreply@innovativearchitects.com.You have 5 days from the time this application is submitted to complete the electronic disclosure form:
Select one*

I acknowledge I must complete the electronic disclosure form via email from noreply@innovative architects.com to proceed with the background check.I do not have the ability to complete the electronic disclosure form via email which may cause the background check to close
Fingerprints (Select one)*

For those who are in Utah: I request the fiscal agent to send the Livescan AuthorizationForm and will do Livescan fingerprintsFor those who are not in Utah: I am submitting 2 copies of rolled fingerprints with this application.
Signatures

I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent allowed by applicable law. Please see the Consumer Consent Disclosure at https://www.jotform.com/consumer-consent-disclosure/
Employee Signature*

Clear
Date of Signature*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

	State	County	From (Month/Year)	To (Month/Year)
State 1
State 2
State 3

Utah Background Screening Application- Adult

Utah Background Screening Application- Adult

Signatures