As   

, I request that 
a  criminal  background  check  or  investigation  be  conducted  on  the  applicant  named  below  for 
purposes of evaluating this applicant for employment in the position stated below.  

 

 

 

 

 

 

 

 

I understand that no offer of employment will be or can be extended to the applicant until 
after written  approval signed by  the  Director or  Assistant Director  of the Human Resources of  
the AOC authorizing the employment of the applicant is obtained.        

Position/Job Title    ____________________________________________________________ 

Full Name of Applicant/Volunteer  _______________________________________________ 

Social Security # 

  Driver’s License No.   _____________________

 

Date of Birth   ___________________   Sex  _________   Race 

  

________________________

Current Address   _____________________________________________________________ 

Date 

Date 

 

________________________ 

___________________________________________ 
Print/Type Name of the official making the request  

________________________ 

Telephone #

_______________________________

____________________________________________ 
Signature of Applicant 
 
(Signature denotes authorization from applicant to conduct background check) 

                   

 

 

 

    _

____________________________________________
Signature of the official making the request    

Form should be forwarded to: 

Attn:  AOC Human Resources Department 
Vonda C. Sanders, Director of Human Resources 
300 Dexter  Avenue 
Montgomery, Alabama  36104 

Do not write below this line.  For AOC HR Personnel Use Only 
------------------------------------------------------------------------------------------------------------------------------- 

Background Check Results:

 

 

Approved for hire 
   
Disapproved for hire 

 

 

Date:_______________

Date:_______________

Signature of HR Personnel Conducting Background Check:_________________________________ 

PLEASE ALLOW 7 CALENDAR DAYS FOR PROCESSING 

State of Alabama        
Unified Judicial System 

Form PERS-61  Rev. 11/2022 

REQUEST TO CONDUCT 
CRIMINAL BACKGROUND INVESTIGATION