UCD - Student Loans
UCD is dedicated to ensuring a safe and secure environment for our faculty, staff, students and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees prior to their employment.



Personal and Confidential Statement. Must be thoroughly completed or your transcripts will not be released. For questions regarding this form, please contact Claudia Dooley at (303-315-1828).
At least 3 references, none of which have the same address, are required. Parent's living at the same address are considered 1 reference.

Please Note:
If you have recently completed the personal information form (within the last 30 days) it is not necessary to complete this form again, please indicate the confirmation number in the box below:

Confirmation Number:


Personal Information
Student ID#
Email Address
Name
Local Address
Local City State: Zip Code:
Do you own this property?
Local Phone
Permanent Address
Permanent City State: Zip Code:
Permanent Phone
Place of Birth
Date of Birth
Number of Dependents
Are you working?   Where?
Driver License State Issued

Parents Information (if deceased indicate n/a)
Father's Name
Father's Address
Father's City State: Zip Code:
Father's Phone
Father's Employer
Father's Work Phone

Mother's Name
Mother's Address
Mother's City State: Zip Code:
Mother's Phone
Mother's Employer
Mother's Work Phone

Spouse Information
Marital Status Since:
Spouse's Name
Spouse's Address
Spouse's City State: Zip Code:
Spouse's Phone
Spouse's Employer
Spouse's Work Phone


Parents of Spouse Information (if deceased indicate n/a)
Father's Name
Father's Address
Father's City State: Zip Code:
Father's Phone
Father's Employer
Father's Work Phone

Mother's Name
Mother's Address
Mother's City State: Zip Code:
Mother's Phone
Mother's Employer
Mother's Work Phone

Relative Information
Relationship
Relative's Name
Relative's Address
Relative's City State: Zip Code:
Relative's Employer
Relative's Phone

Friends / Reference
Friend's Name
Friend's Address
Friend's City State: Zip Code:
Friend's Phone
Friend's Employer
Friend's Work Phone

Friend's Name
Friend's Address
Friend's City State: Zip Code:
Friend's Phone
Friend's Employer
Friend's Work Phone

I certify that the above information is correct and complete to the best of my knowledge.