A-018 Background Check Application I understand that I am required to successfully pass a criminal background check in order to join the Washington State Animal Response Team as a volunteer. I also understand that I will be notified of the response of the criminal background check within 10 days of the Washington State Response Team’s receipt thereof.Contact InformationName(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State ZIP / Postal Code Home Phone(Required)Work PhoneMobile PhoneEmail(Required) Other Names/Aliases by which I have been known in the past.- - - I have/have not been convicted of the following crime, had findings made against me in a civil adjudicative proceeding, or have had both a conviction and findings made against meName of EventCourt NameCity, County, StateConviction/FindingsDate event Concluded MM slash DD slash YYYY - - -Name of EventCourt NameCity, County, StateConviction/FindingsDate event Concluded MM slash DD slash YYYY - - - Agreement and Signature By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.Signed (type name)Date MM slash DD slash YYYY
