Criminal Background Check Authorization

Criminal Background Check Authorization
The safety of our campers is a top priority. Leader candidates age 18+ must fill out this authorization for a criminal background check. Your information will be submitted to PreSearch Background Services to generate a criminal background check report. All information received in this report will be maintained in a confidential manner to protect your personal information.
Name*

First NameMiddle NameLast Name
Former Name(s) and Dates Used*
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Social Security Number*
Phone Number*

Area CodePhone Number
Driver's License Number *
Driver's License State/Province*
Email*
example@example.com
Confirm Email*
example@example.com
By submitting this form I hereby authorize Pleasant Valley Christian Camp to order a Criminal Background Check report.
Should be Empty: