Get IL IHF CAF - Chicago 2010-2024

IHF INDIVIDUAL HISTORY FORM - CAF FORM REQUIRED For any individual undergoing a background check in relation to a City of Chicago Children s Activities Facility business license. This form must be signed by the individual whose information is provided and notarized. A PHOTOCOPY OF CURRENT GOVERNMENT-ISSUED PHOTO ID MUST ALSO BE INCLUDED FOR THE INDIVIDUAL. PERSONAL INFORMATION PROVIDE THE FOLLOWING PERSONAL INFORMATION First Name Middle Name Current Residential Address Last Name Suite/Apartment/Unit Home Phone Work Phone City Cellular Phone Driver s License/State ID Social Security Height FT. / Age Sex M Eye Color Yes F Corporate Title/Relationship to Applicant No If Yes year of printing Current Marital Status check one Married Divorced IF YOU ARE APPLYING FOR A CHILDREN S ACTIVITIES FACILITY LICENSE AND YOU OWN 5 OR MORE INTEREST EITHER DIRECTLY OR INDIRECTLY IN THE APPLICANT ENTITY THEN YOUR CURRENT SPOUSE MUST COMPLETE A SPOUSAL AFFIDAVIT FORM AND PROVIDE A PHOTOCOPY OF CURRENT GOVERNMENT ISSUED PHOTO ID. Widowed If married or divorced provide spouse or ex-spouse s name below Current Last Name CRIMINAL HISTORY Place of Birth LBS. MARITAL HISTORY Have you ever been convicted of a criminal offense ZIP Code Single State Hair Color IN. Suffix Email Address Date of Birth - Maiden Name Maiden Name/Married Name If Yes please list Crime 1 Location Disposition Crime 2 EMPLOYMENT HISTORY PROVIDE YOUR EMPLOYMENT HISTORY FOR THE PAST 5 YEARS INCLUDE AN ATTACHMENT IF NECESSARY Most Recent Employer s Name Employer s Phone Employer s Address Job Title Type of Work Second Most Recent Employer s Name From ACKNOWLEDGEMENT Employed To Immediate Supervisor To REVIEW THE FOLLOWING STATEMENT AND SIGN YOUR ACKNOWLEDGEMENT BELOW I hereby certify that the information supplied in this form is true and complete and hereby authorize the City of Chicago to make all necessary inquiries to verify its accuracy. INSTRUCTIONS Provide the information requested below. If more room is needed to complete any of the following sections include an attachment. This form must be signed by the individual whose information is provided and notarized* A PHOTOCOPY OF CURRENT GOVERNMENT-ISSUED PHOTO ID MUST ALSO BE INCLUDED FOR THE INDIVIDUAL* PERSONAL INFORMATION PROVIDE THE FOLLOWING PERSONAL INFORMATION First Name Middle Name Current Residential Address Last Name Suite/Apartment/Unit Home Phone Work Phone City Cellular Phone Driver s License/State ID Social Security Height FT. / Age Sex M Eye Color Yes F Corporate Title/Relationship to Applicant No If Yes year of printing Current Marital Status check one Married Divorced IF YOU ARE APPLYING FOR A CHILDREN S ACTIVITIES FACILITY LICENSE AND YOU OWN 5 OR MORE INTEREST EITHER DIRECTLY OR INDIRECTLY IN THE APPLICANT ENTITY THEN YOUR CURRENT SPOUSE MUST COMPLETE A SPOUSAL AFFIDAVIT FORM AND PROVIDE A PHOTOCOPY OF CURRENT GOVERNMENT ISSUED PHOTO ID. Widowed If married or divorced provide spouse or ex-spouse s name below Current Last Name CRIMINAL HISTORY Place of Birth LBS* MARITAL HISTORY Have you ever been convicted of a criminal offense ZIP Code Single State Hair Color IN* Suffix Email Address Date of Birth - Maiden Name Maiden Name/Married Name If Yes please list Crime 1 Location Disposition Crime 2 EMPLOYMENT HISTORY PROVIDE YOUR EMPLOYMENT HISTORY FOR THE PAST 5 YEARS INCLUDE AN ATTACHMENT IF NECESSARY Most Recent Employer s Name Employer s Phone Employer s Address Job Title Type of Work Second Most Recent Employer s Name From ACKNOWLEDGEMENT Employed To Immediate Supervisor To REVIEW THE FOLLOWING STATEMENT AND SIGN YOUR ACKNOWLEDGEMENT BELOW I hereby certify that the information supplied in this form is true and complete and hereby authorize the City of Chicago to make all necessary inquiries to verify its accuracy. .