Apply for a Background Check and Fingerprinting

The screening process for City of Rockville employment, volunteer, or contractor positions may include one or more of the following:

Background check: Verifies previous work experience and professional or educational credentials using the Social Security number and date of birth you provide.
Criminal background check: Conducted through the Criminal Justice Information System (CJIS) and the FBI. To obtain a CJIS report, you must submit a complete and legible set of fingerprints, taken by Human Resources personnel or a local law enforcement agency.
Motor vehicle records check: Determines whether the candidate is suitable to operate a motor vehicle during the performance of regular duties.
CDL medical examination: Conducted through Concentra. The U.S. Department of Transportation (DOT) regulates medical standards for holders of commercial driver’s licenses (CDL drivers).
DOT drug and alcohol screening: Also conducted through Concentra. In addition to the physical examination, all drivers are subject to DOT drug and alcohol screening requirements.

Background Check and Fingerprinting Application

Reason for Background Check(Required)

Volunteer/Contracting Program(Required)

Position Title of Employment(Required)

Name(Required)

First Middle Last

Date of Birth

Gender(Required)

Skin Tone(Required)

Hair Color(Required)

Eye Color(Required)

Height in Feet/Inches (Example: enter 603 for 6' 3")

Weight in Pounds

Race(Required)

Place of Birth (State or Country)(Required)

Citizenship (Country)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Daytime Phone(Required)

Evening Phone

Driver’s License/ID Card Number: All numbers and letters – no dashes. Enter N/A if it does not apply

Driver’s License/ID Card State (Two Letter State Code)

Driver’s License/ID Card Expiration Date

Self-Scheduling Appointment: Fingerprinting will take place at the Human Resources Department on the second floor of Rockville City Hall located at 111 Maryland Ave., Rockville, MD 20850. Fingerprinting will take approximately 20 minutes. Please self-schedule your appointment at the following link: https://calendly.com/afuhrman/fingerprinting-city-of-rockville(Required)

I have scheduled my appointment at the provided link.

Screening Disclosure and Authorization: I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any consumer report of which I am the subject upon written request. I also understand that I may receive a written summary of my rights in accordance with 15 U.S.C. §1681 et. Seq. I agree that this authorization shall remain valid for the duration of my employment, volunteering, and contract with the City of Rockville. I certify that the information contained on this authorization form is true and correct and that I may be subject to adverse action, up to and including termination based on any false, omitted, or fraudulent information.(Required)

Agree

Contact

Human Resources Department
240-314-8470
hrinfo@rockvillemd.gov

Hours
Monday – Friday
8:30 a.m. – 5 p.m.

Address
Rockville City Hall
111 Maryland Ave.
Rockville, MD 20850

Apply for a Background Check and Fingerprinting

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Background Check and Fingerprinting Application

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