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Social Security #
Driver's License State
Date of Birth
Language or Signing Skills
Convicted of a felony
Have you ever been convicted of a felony?
If you have ever been convicted of a felony, please explain.
Institution(s) in which you were incarcarated.
Federal or State Prison Employee
Have you ever worked for the Federal or any state prison system?
Prison Employee Explanation
If you have worked for the Federal or any state prison system, please explain.
Relatives as Prison System Employees
Do you have any relatives working in the prison system?
If you have any relatives working in the prison system, please provide their Name, Relationship, & Location
If you are on an inmate's visitation list, have any communication with, or have incarcerated relatives in the event area, please indicate unit name and Inmate name.
Submission of this application constitutes an understanding and agreement with Fly Right, Inc. and all other institutions involved. All above information is true and accurate to the best of my knowledge and belief. I hereby authorize the applicable Department of Corrections, correctional institution and/or this ministry to conduct a criminal background check to verify this information. I agree to abide by all the rules and policies of the correctional institution and this ministry. I also agree to hold harmless Fly Right, Inc. and the institutions that I am assigned to for any harm whatsoever that could form the basis of a claim before, during or after events.
Church You Attend
Pastor First Name
Pastor Last Name
Church Address Line 2
Church Zip Code
Sponsor's First Name
Sponsor's Last Name
First Name You Use
Driver's License # (Alpha-Numeric)
Emergency Contact Name
Who should we contact in case of emergency?
Emergency Contact's Phone
Fly Right Ministry