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Rev. 4/20
CRIMINAL BACKGROUND CHECK AUTHORIZATION FORM
City of Harker Heights
Planning & Development
305 Millers Crossing
Harker Heights, TX 76548
Phone: (254) 953-5600
Name (Last, First, Middle) :
Other Name(s) Used:
Current Street Address:
City: State: Zip:
Date of Birth: Driver's License State: Driver's License Number:
I hereby acknowledge and affirm that the information provided on this document is current and accurate. I
understand it will be utilized by the City of Harker Heights to conduct a criminal background check on me, and by
signature below, authorize the City of Harker Heights to conduct the criminal background check.
Printed Name Signature Date
Venue Owner Manager OtherPlease Select Your Title:
Per Harker Heights Code of Ordinances Section 125.08 Permit Application
(A) A person who seeks a permit to operate a BYOB venue must submit an application to the
Director on a form provided by the Director. The application must include:
(1) The names, addresses, and birth dates of all persons who have ownership interest in, or who will
manage, the proposed BYOB venue;
(2) Authorization for the City to conduct a criminal background check on each person described in
paragraph (1)
Phone: E-mail:
