County: Telephone Number: Date of Birth: Gender: ( ) - Male Female Residence Business Cell Do you have a Social Security Number: Yes No If the person has been issued a social security number, If this person does not have a Social Security Number, (SSN), it must be provided to ensure the background you must enter one of the following valid alternate check result is valid: Please list the SSN below: number types: Alternative ID Type: Driver License: Number: State: State ID: Number: State Permanent Residency Card Number: Passport Number: Country Canadian SIN Number: Military ID Number: Has this person lived outside of Texas in the last 5 Years: Birth City: Yes Birth State: No Enter the previous physical address(es) for the background check subject in the space provided: Ethnicity (must accompany race): Race: Hispanic White American Indian/Alaskan Native Non-Hispanic Black Native Hawaiian/ Pacific Islander Asian
County: Telephone Number: ( ) - Residence Business Cell Date of Birth: Gender: Male Female Do you have a Social Security Number: Yes No If the person has been issued a social security number, (SSN), it must be provided to ensure the background check result is valid: Please list the SSN below: If this person does not have a Social Security Number, you must enter one of the following valid alternate number types: Alternative ID Type: Driver License: Number: State: State ID: Number: State Permanent Residency Card Number: Passport Number: Country Canadian SIN Number: Military ID Number: Has this person lived outside of Texas in the last 5 Years: Yes No Birth City: Birth State: Enter the previous physical address(es) for the background check subject in the space provided: Ethnicity (must accompany race): Hispanic Non-Hispanic Race: White Black Asian American Indian/Alaskan Native Native Hawaiian/ Pacific Islander
Form-F-500-2971c-Request-Criminal-History-DFPS-History-Ck-07-2017.docx