Criminal Check Release | Crawford County Commission on Aging

Crawford County Commission on Aging Criminal History Information Questionnaire

I authorize Crawford County Commission on Aging (COA), 308 Lawndale St., Grayling, MI 49738, to obtain a criminal history report(s) during the employment/volunteer application process. I understand that such reports may also be obtained annually during my employment or volunteer service with COA, if required by a program, contract or a need is identified.

In order to obtain this report, the following information is required and will be kept confidential. It will be maintained in a separate file from my application. The information provided below will only be used to identify my criminal history, if any.

I have read this form and I am providing this information on a voluntary basis. I acknowledge that I am signing this form as a normal part of the COA employment/volunteer process.
Which one applies to the reason you are filling out this form?*
- Employee
- Employee Applicant
- Volunteer
Gender*
Date of Birth*
MM slash DD slash YYYY
Name*
First Middle Last
If you do not have a middle name, type in N/A in the middle name field.
Address*
Street Address City State ZIP Code
Phone*
Race*
- White
- Black
- Hispanic
- Asian/Pacific Islander
- American Indian
Email
Provide any other name(s) previously used (include aliases, maiden, married or N/A):*
Today's Date*
MM slash DD slash YYYY
Authorization*
- By checking this box, I hereby authorize Crawford County Commission on Aging to conduct criminal history check(s).
Phone
This field is for validation purposes and should be left unchanged.

Crawford County Commission on Aging Criminal History Information Questionnaire