Background Check - 2018 Inquiry Authorization Release Form

Background Check Release
Welcome! The next step in your process is to complete the authorization form so we can complete a criminal background check.

This form has two components:
- A Summery of Your rights Under the Fair Credit Reporting Act
- Disclosure and Authorization
Thank you for completing this form. We will keep your information secure and not use it for any other purpose.
Disclosure: We (Ft. Caroline Baptist Church) will obtain one or more consumer reports or investigative consumer reports (or both) about you for employment purposes. These purposes may include hiring, contract, assignment, promotion, reassignmnet, and termination. The reports will include information about your character, general reputation, personal characteristics, and mode of living. We will obtain these reports through a consumer reporting agency. Our consumer reporting agency is backgroundchecks.com ("BGC"). BGC's address is P.O. Box 353, Chapin, SC 29036. BGC's telephone number is (866) 265-6602. To prepare the reports, BGC may investigate your education, work history, professional licenses and credentials, references, criminal record, lawsuits, driving record, credit history, and any other records with public or private information sources. You may inspect BGC's files about you (in person, by mail, or by phone) by providing identification to BGC. If you do, BGC will provide you help to understand the files, including trained personnel and an explanation of any codes. Another person may accompany you by providing identification. If BGC obtains any information by interview, you have the right to obtain a complete and accurate disclosure of the scope and nature of the investigation performed. The Federal Trade Commission provides a summary statement of your rights on its website at http://www.ftc.gov/credit.
Full Legal First Name *
Middle Name
Last Name *
Maiden
Other names used:
Current address
from Mo/Yr *
Street *
City, State & Zip *
Former Addresses
From Mo/Yr *
To Mo/Yr *
Street *
City, State & Zip *
From Mo/Yr *
To Mo/Yr *
Street *
City, State & Zip *
Required Information

Some government agencies and other information sources require the following information when checking for records. Our agency will not use it for any other purposes.
Date of birth *

Month Day Year
Date
Social security number *
Driver's license number *
Driver's license issued state *
Name as it appears on license *
Email address *
example@example.com
Report Copy:

If you are applying for a job or live in California, Minnesota, or Oklahoma, you may request a copy of the report by checking this box
Authorization: By signing below, you authorize: (a) BGC to request information about you from any public or private information source; (b) anyone to provide information about you to BGC; (c) BGC to provide us one or more reports report based on that information; and (d) us to share those reports with others for legitimate business purposes related to your employment. You acknowledge receiving the Federal Trade Commission's "Summary of Your Rights under the Fair Credit Reporting Act." You acknowledge that a fax, image, or copy of this authorization is as valid as the original. You make this authorization to be valid for as long as you are an applicant or employee with us.
Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

Background Check Release

Current address

Former Addresses

Required Information