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Rev: 10/14/2019
Disclaimer and Signature
I hereby authorize Maricopa County Security Services Division to conduct a Criminal History/Records check and Warrants check for the purpose of issuing a
Maricopa County Contractor ID Card. I understand that, should this card be issued to me, it will be displayed only when I am on/in a Maricopa County facility and
that it should only be used to access Maricopa County facilities for official purposes related to my employment.
I agree that the information provided on this application is accurate and that any false information provided may result in the non-issuance of an ID card or the
loss of such privileges.
Areas of Access Needed (FOR COUNTY USE)
Hours of Access: ☐ Business Hours ☐ 24 Hour
Access Schedule: ☐ Monday – Friday ☐ Monday – Sunday ☐Other (Specify): _________
*List of Buildings (include building name or address and specify access areas):
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I HAVE CONFIRMED THAT THE REQUESTED ACCESS IS APPROPRIATE AND NECESSARY IN ORDER FOR THE APPLICANT TO FULFILL THEIR
CONTRACTUAL OR VOLUNTEER DUTIES.
I HAVE VERIFIED THAT THIS APPLICATION IS COMPLETE AND THAT A COPY OF THE APPLICANT’S DRIVER’S LICENSE OR GOVERNMENT ISSUED
ID HAS BEEN SUBMITTED ALONG WITH THIS APPLICATION. I UNDERSTAND THAT INCOMPLETE APPLICATIONS WILL BE REJECTED.
County Authorized Signature:
FOR SECURITY SERVICES USE ONLY
BACKGROUND CHECK COMPLETED BY:
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