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Background Check Investigation Request Form

IMPORTANT NOTE: All offers made for employment are contingent upon completion of a satisfactory background investigation and/or credit check. It is important that any oral or written offer contain this acknowledgement. All fields are required.

Applicant's Last Name:
Applicant's First Name:
Applicant's e-mail Address:
Position Title:
Position Number:
Requisition Number:
Is this applicant a current TTUHSC employee?
Does this position handle a procurement card and/or money (cash, co-pay, etc)?
Does this position need a professional license (LVN, RN, etc)?
Does this position work with minors (under the age of 18) in camps and/or programs affiliated with TTUHSC?
Requesting Department:
Contact's Name :
Contact's Phone Number :
Contact's e-mail Address:


If you have any questions about this form send us an email to: