Volunteer Application Form

Request for Criminal Record

MAIDEN/ALIAS

ATTENTION YOUTH SERVICE PROVIDERS

Sections 43.540 and 589.400 RSMo. The Criminal History Record Check document, signed by the applicant, will serve as written consent to check criminal record and offender information by the requestor. The information obtained shall be confidential and any person who discloses the information beyond the scope allowed in Sections 43.540 and 589.400 RSMo. shall be subject to prosecution for a Class A misdemeanor.

REQUESTING ENTITY

The Requesting Entity is for office use only. Do not fill out the information below this section. Submit the form with the button below.

 

reCAPTCHA is required.