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Username
E-mail
SSN Social Security #
Work Phone
Cell Phone
Marital Status Single Married
Spouse's Name
Driver's License State
Date of Birth
Gender
Race
Language or Signing Skills
Convicted of a felony No Yes Have you ever been convicted of a felony?
Felony Explanation If you have ever been convicted of a felony, please explain.
Incarcarated Institutions Institution(s) in which you were incarcarated.
Federal or State Prison Employee No Yes 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 No Yes Do you have any relatives working in the prison system?
Relatives Explanation If you have any relatives working in the prison system, please provide their Name, Relationship, & Location
Visitation List 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.
Agreement Yes 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
Church Phone
Pastor First Name
Pastor Last Name
Church Address
Church Address Line 2
Church City
Church State
Church Zip Code
Sponsor's First Name
Sponsor's Last Name
Christian Testimony
First Name You Use
Driver's License # (Alpha-Numeric)
Emergency Contact Name Who should we contact in case of emergency?
Emergency Phone Emergency Contact's Phone
