Forms • Libertyville • CivicEngage

Request for Police Local Background Check

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First Name*

Middle Initial

Last Name*

Maiden Name

Date of Birth (please format MM/DD/YEAR)*

Street Address*

City*

State*

ZIP Code*

Phone Number*

E-Mail*

Reason for Background Check Request:*

Number of original documents requested:*

By submitting this request, I certify that all information contained in this request is complete and accurate. I hereby further authorize the Libertyville Police Department to conduct a local background check using files pertaining to both traffic and criminal arrests under the listed name.

I hereby release the Libertyville Police Department, including its officers, employees, or related personnel, both individually and collectively, from any and all liability for damages of whatever kind which may result due to compliance with this authorization and request to release information*

I have read, understand, and agree to the background check waiver.

I do not agree to the background check waiver.

Please note: You will be contacted by the Libertyville Police Department Records Unit when your request is completed. This typically takes up to 5 business days from the date of request.

* indicates required fields.

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Village of Libertyville

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