HPD-090 (Rev. 07-18) Pg. 2 of 2
All Additional Employment for Applicant in the Past 12 Months
Required Documents & Fee
$50.00 Non-refundable Application Fee (No cash or credit cards accepted.)
(Payable to City of Hilliard) ______Money Order
Show valid driver’s license or government issued identification. If applicant is not a U.S. citizen, show valid
passport from country of origin and proof of legal entrance into the U.S. and authorization to work.
Provide, in its entirety, a copy of recent Ohio Bureau of Criminal Investigation (BCI) or Federal Bureau of
Investigation (FBI) background results. Any WebCheck location can submit your fingerprints to BCI/FBI;
however, as a courtesy, we have provided the information for two local companies. Request that the
WebCheck processor send the BCI/FBI results directly to you, NOT the City of Hilliard.
• Northwest Kiwanis Deputy Register, 4740 Cemetery Road, Hilliard, Ohio 43026. Ph: 614.529.1203
• Biometric Information Management, 6059 Frantz Rd, Ste 102, Dublin, Ohio 43017. Ph: 614.456.1296
Photo Taken On-site
I certify that all information provided on this application is correct. I certify that any criminal history I have has
been included with this application. I understand that any falsification will result in revocation of the permit.
I certify that, if granted a permit, I will not use the permit as an endorsement by the City, a city department or city
employee of my company or products or services peddled/solicited.
I certify that I have been given a copy of Chapter 745 of the City of Hilliard Codified Ordinances.
I certify that, if granted a permit, I will maintain compliance with Chapter 745 of the City of Hilliard Codified
Ordinances and all applicable county and state statutes, rules and regulations that affect transient vendors.
Applicant Signature: ______________________________________________________ Date: ________________________________
For Administrative Use Only
ID Tag/License Printed Called/Left Voicemail for Pickup