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Step One

First Name*
Last Name*
Date of Birth*
Date of Birth
Social Security Number*
Company
Email*
Phone*
Address*
City*
State*
Zip Code*
Sex
Race
Height
Weight
Eye Color
Hair Color
State Issued Photo ID Type*
Please describe the type of ID that you will be bring in for your background check.
State Issued ID Number*
Please insert the corresponding state issued ID number.
I am aware that I must bring in the same ID as listed above to my appointment. *
1. Yes
2. No
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Background Check Detail
There are multiple types of background checks available for purchase. Please check with the agency or organization that needs a copy of your background check prior to your purchase to understand which background check to select. Please note, if you have lived in the state of Ohio for the past five years and you need a background check for employment purposes, you may only need to have a BCI Background Check conducted.
Agreement*
1. Yes
2. No
I have read the above statement and understand that it is my responsibility to purchase the correct background check. The Township will not issue a refund for any improperly purchased background checks.
What is the reason for your background check?
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Authorization
By signing above I certify the personal identifiers provided on this form are accurate and I voluntarily and knowingly authorize the Colerain Police webcheck agency to submit information to the Ohio Bureau of Criminal Identification and Investigation (BC&I) to conduct a criminal records check for information relating to me. I voluntarily and knowingly authorize BC&I to disseminate criminal arrest, conviction and juvenile delinquency adjudication records to the Webcheck provider or agency I have designated to receive this information. I voluntarily and knowingly release and discharge the Ohio Attorney General's Office, BC&I and their employees from all claims and liability related to this authorized criminal record review and dissemination. The authorization waiver is valid for one year from the date this background check was conducted.
Date
Date
Payment Instructions
BCI Fingerprint
BCI Fingerprint
Price
Quantity
Shipping Cost
Taxable
FBI Fingerprint
FBI Fingerprint
Price
Quantity
Shipping Cost
Taxable