Apply for a NCSI Background Check

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.
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 Adventist HealthCare. 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 Adventist HealthCare. In addition to the physical examination, all drivers are subject to DOT drug and alcohol screening requirements.

NCSI Background Check Application

Reason for Background Check(Required)

Volunteer/Contracting Program(Required)

Position Title of Employment(Required)

City of Rockville Supervisor or Contact: Please enter the name of the person with the City of Rockville that will be your supervisor or has been your contact.(Required)

Name(Required)

Please provide your legal name as shown on a driver’s license or other government issued identification.

Prefix First Middle Last Suffix

Date of Birth(Required)

Gender(Required)

Male (M)

Female (F)

Unknown (U)

Former Name/Alias

First Last

Place of Birth (State or Country)(Required)

Citizenship (Country)

Daytime Phone Number(Required)

Email(Required)

SSN Upload: The background check runs on SSN. Please upload an image of your SSN.(Required)

Max. file size: 100 MB.

Address(Required)

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

Country(Required)

Previous Address

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

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.

Agree

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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 NCSI Background Check

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NCSI Background Check Application

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