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Thank you for requesting a room at Ronald McDonald House Charities of Tampa Bay.  We hope to assist your family during this challenging time.

Please NOTE: Starting 8/2/23 there may be a temporary delay in processing background checks while we work with our current provider to amend processes. Because we know that accessing our services is important for your family, we will continue to process intake, but be aware that should there be a report that causes an individual to become ineligible to stay, we reserve the right to evict accordingly. 

EACH PERSON 18 AND OVER THAT IS REQUESTING TO STAY MUST FILL OUT THIS FORM.

Please take time to read the following information about our background check process:

Ronald McDonald House Charities of Tampa Bay (“RMHC”), in order to undertake reasonable efforts to protect the safety of the guest families residing with us, now requires that each individual applicant (age 18 or older) who applies to stay at one of our Houses undergo a formal inquiry into their background (“background check”) to assess whether the guest applicant should not be permitted access to our facilities. This background check will include a private, multi‒jurisdictional database of criminal records as well as a search of the National Sex Offender Public Registry for each individual age 18 or older.

All guest applicants are required to go through this process. You have the right to decline to have this background check performed. However, if you do decline the background check, we will have no choice but to deny your request for access to our facilities out of the need to take all reasonable efforts to protect the safety of our families. Please understand that RMHC solely will obtain a background check to assist it in determining whether to grant you access to our facilities. RMHC is not obtaining a “consumer report” for any other purpose. RMHC will not be conducting a credit check. By accepting this authorization, you authorize us to obtain the background report described in it from a consumer reporting agency.

This background check will be conducted by a third party. Results of the background check are sent directly to RMHC. The information obtained during the background check process will only be used by RMHC to determine whether to grant access to our facilities.  The information will not be disclosed for any other reason.

If you have failed the background check, you will need to find other accommodations. Other individual members of your family/group, who pass the background check may be permitted access to our facilities with a passing background check.

Individuals will be denied who have been convicted of violent crimes, crimes against children, sexually related offenses, and other serious or repeat convictions that may affect the safety of a community environment.
To assist RMHC in obtaining criminal history background check information, please truthfully and completely answer the following questions:

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* 1. What is your legal first name?

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* 2. What is your legal middle name?

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* 3. What is your legal last name?

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* 4. What is your maiden name, if different from your last name?

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* 5. Please enter your date of birth in the following format: MM/DD/YYYY

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* 6. Contact Information

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* 7. Have you ever been convicted of ANY felony or misdemeanor (other than moving vehicle or parking violations)?  For purposes of this inquiry, the word "convicted" includes, without limitation, pleading guilty, pleading no contest, or having a judicial finding of guilt.

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* 8. If applicable, please enter the year and conviction(s) in the box below.  Note whether the charge was a misdemeanor, felony, or other.

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* 9. I certify that all of the above-provided information is accurate, complete and can be verified.  I agree and understand that any falsification, misrepresentation, or omission may disqualify me from seeking temporary residence at RMHC; or if temporary residence already has been granted, then it will subject me to immediate expulsion from RMHC whenever the falsification, misrepresentation or omission is discovered.  I also understand that while RMHC will obtain criminal history background information on potential temporary residents, it cannot and does not guarantee the personal safety of any temporary resident, guest, visitor or staff member.

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* 10. I confirm that I am 18 years or older and am filling out this form on behalf of myself, and not for other members of my party.

The next page is the Authorization Form which must be provided by law and explains all of your rights under the Fair Credit Reporting Act.  RMHC is requesting the report to run a criminal history background check and will NOT be conducting a credit check.

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