Auxiliary Girls State Background Check

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* Required information.




**Please only fill this out if you are going to be a COUNSELOR for American Legion Boys / Girls State. Delegates DO NOT fill this out**





Date * 1000
First Name *
Full Middle Name *
Last Name *
Street Address *
City *
State *
Zip Code *
List Any Previous Names
Date Of Birth *
Social Security # *
Sex *
Driver's License # *
State *
Have you ever been convicted of a crime ? *
If Yes, Please Explain

Please list any previous addresses for the past 10 years.

City, State & Zip Code


Criminal background checks may be conducted on volunteers. I authorize the American Legion Boys / Girls State (ALBS / ALGS) to conduct such a check. I release the ALBS / ALGS and its employees from any claims arising out of a criminal background check. If a determination is made that a person may not serve as a volunteer due to the criminal background check, I may inspect and challenge the information received by the ALBS / ALGS.



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