Ronald McDonald House Charities of South Florida (RMHC) places a high value on the safety and welfare of its residents and their families. RMHC evaluates all individuals applying for temporary residence at RMHC in accordance with applicable federal and state laws and its current policies and practices. One of the ways in which RMHC evaluates applicants is by conducting criminal history background checks on all individuals (18 years old or older) applying for temporary residence at RMHC. In accordance with applicable law, RMHC may use the information it obtains from a criminal history report to deny an application for temporary residence.

Each family member (18 years old or older) who intends to apply for temporary residence must separately fill out Background Check Form to obtain a Criminal History Report. Once we receive the completed forms, RMHC will engage a consumer-reporting agency to conduct a background check. Thereafter, RMHC is authorized to obtain consumer reports at any time during a period of temporary residence pursuant to the Background Check Form.

RMHC, in its sole discretion, will determine whether your criminal record may threaten an individual’s health, safety, welfare, and ability to peacefully enjoy the RMHC facility and, therefore, result in your application for temporary residence being denied or your temporary residence being terminated. You are required to immediately notify RMHC's House Manager if your answer to the Background Check questions are inaccurate or changes.
Last Name
First Name
Middle Name
Maiden Name
Federal EIN Number
Street Address of Residence
City of Residence
State of Residence
Zip Code of Residence
Region of Residence
Country of Residence
Government ID
Date of Birth: mm/dd/yyyy
Social Security Number
Hire Date: mm/dd/yyyy
Citizenship Status
Employee Signature Date
Alien Identification (Registration) Number
Alien I-94 (Admission) Number
Alien Authorized to work until
Document Type
Issuing Authority
Document Number
Expiration Date (if any): mm/dd/yyyy
Preparer Name
Preparer Address
Preparer City
Preparer State
Preparer Zip Code
Preparer Date: mm/dd/yyyy
Company Name
Employer Name
Employer Phone
Employer Title
Employer Address
Employer City
Employer State
Employer Zip Code
Review Name
Reference Code
Second Reference Code
Package Name
Degree Type
Verification Type
Company City
Company State
Company Zipcode
Company Country
Name (First Last) While Enrolled
Start Date
End Date
Graduation Date
Company Name
Company Location
Company City
Company State
Company Zipcode
Company Country
Phone Number
Start Date
End Date
Company Contact
Name of Reference
Phone: 555-555-5555
Reference Type
Custom Question
Organization Name
License Type
License Number
Received on Date: mm/dd/yyyy
Expires on Date: mm/dd/yyyy
Company Name
Company Location
Phone Number
Start Date
End Date
Company Contact
Landlord/Management Company
Property Name
Property Address
Monthly Rent
Phone Number: 555-555-5555
Fax Number: 555-555-5555
Rental Start Date
Rental End Date
Years to Search
Reason For Test
Applicants Phone: 555-555-5555
Regulation Type
Credit Type
Spouse First Name
Spouse Middle Name
Spouse Last Name
Spouse SSN