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Rochester Institute of Technology (RIT)
Adjunct or Director of Camp/Program with Minors Background Screening Authorization
RETURN FORM TO: HUMAN RESOURCES 5th Floor Eastman Hall
Fax: 585-475-7170
Email: [email protected]
Position Type (check one)
Adjunct
Director of Camp/Programs with Minors
Dept. Name:
Supervisor Name:
Other Dept. Contact Name:
☐ Pre-Employment Criminal Background
Check, Sex Offender Registry, Student
Conduct for current or previous RIT Students
(for all new hire adjunct faculty)
Title:
Ext:
Ext:
Type of Check(s)
☐ Motor Vehicle Record (student workers, staff and faculty employees) only required
when driving is an essential function of the job.
Job duties that require driving:
Last Name:
First Name:
MI:
Current Home Address:
State:
City:
Zip:
Email:
Phone:
Previous Home Address:
City:
State:
Driver’s License Number:
State:
Other names you have used:
*Social Security Number:
Current or Prior RIT Student: ☐ Yes
**Date of Birth:
)
(Years:
Zip:
Name on Licen