Background Check Form

First Name *

Middle Name *

Last Name *

Social Security Number *

Drivers License Number *

State *

Date of Birth *

Telephone Number *

Email *

Experienced? *

YesNo

Volunteer Interest

Select all that apply to your interest.Youth Dove HuntGirls Deer HuntBoys Deer Hunt

Note Convictions of misdemeanors or felony crimes DO NOT automatically drop off your record after a specific period of time. The court must be petitioned in order to have any conviction of a crime removed. False or erroneous responses to any questions below may result in your not being allowed to volunteer with the Northwest Texas Field & Stream.

1. Have you ever been convicted of a crime which is drug related or related to child abuse? *

YesNo

2. Have you ever been convicted of major traffic violations, including DUI or DWI? *

YesNo

3. Have you ever been convicted of any class A or B misdemeanor or felony crimes? *

YesNo

4. Have you been arrested for a crime for which there has not been an acquittal or dismissal? *

YesNo

Note If you answered Yes to any of the above, please complete the following:

Date of Offense

County

State

Type of Offense

Explanation

The facts set forth on this form are true and accurate to the best of my knowledge. I understand that false statements on this form shall be considered sufficient cause for non-consideration as a volunteer. By my signature I authorize the Northwest Texas Field & Stream to perform a background check. I understand that this information will be used to determine my eligibility as a volunteer with the Northwest Texas Field & Stream. I agree to the use of any photographs taken for use on NWTF & S website and/or in the newsletter.

I, the undersign, do, for myself, any heirs, executors and administrators, hereby release and forever discharge and agree to indemnify the Northwest Texas Field & Stream and each and all of their officers, directors, employees and agents and hold them harmless from and against any and all causes of actions, suits, liabilities, costs, debts, and sums of money, claims and demands whatsoever (including claims of negligence of the Northwest Texas Field & Stream) any and all related attorney’s fees, court costs and other expenses resulting from the investigation of my background in connection with my application to become a volunteer/staff member.

Note If you are accepted by the Northwest Texas Field & Stream Confidential Information Background Investigation committee, as a volunteer...you will be required to come to the office and sign a printed copy of this form. Thank you for your interest as a volunteer.

Background Check Form

Northwest Texas Field & Stream Confidential Information Background Investigation Form

Completion of this form is required of volunteers for the Northwest Texas Field & Stream

Please respond to the following questions:

Verification