HomeMy Public PortalAboutBackground Check RequestWATERTOWN POLICE DEPARTMENT '630
Bureau of Administrative Services �y
552 Main Street, Watertown, MA. 02472
Records Telephone (617) 972-6527
Request for a WATERTOWN ONLY background check
Please print neatly
REQUESTING PARTY
Today's Date:
Individual who is requesting the background check
Telephone number(s) where you can be reached
Your current address :
Agency requesting or Relationship to individual being checked
Copy of Agency ID or Driver's License allowed: Yes No
INDIVIDUAL REQUESTING BACKGROUND CHECK ON
Full Name:
Date of Birth:
Social Security Number:
Driver's License Number:
Sex: Female / Male (circle one)
Background Liability Release attached Yes No
Did the individual work and/or live in Watertown? live work Time frame to
Watertown address of the individual's residence and/or employer:
Purpose of the request? (Ex : employment, immigration, adoption, visa, etc) :
Official Stamp/Seal requested Yes No
Signature :
month /year month / year
(no fee for stamp, $1 fee for embossed seal)
Date :
NOTE : Release of any record is subject to the provisions and allowable fees of the Public Records Laws. All
estimated fees to be paid by Bank Check payable to the Town of Watertown. (no personal checks allowed, estimated
fees to apply to 5 record pages or more) If payment has not been received within ten days, we will close this request
without any action. TIME requirements: Generally notification is made within 10 business days of the date of the
request. You will be notified when the results are ready to be picked up or mailed upon prior agreement. Results will
be held at the records desk for 10 days after the date they are completed for agreed upon station pickup.
For your convenience, please do not come to the station for the results until you have been notified.
Form Date: June 25, 2014