PAO - Permission to Obtain a Background Check

Permission to Obtain a Background Check

(This form authorizes the church to obtain background information and must be completed by the applicant. The church must keep this completed form on file for at least two years after requesting a background check)
I, the undersigned applicant (also known as “consumer”), authorize Emmanuel Faith Community Church through its independent contractor, Trak-1, to procure background information (also known as a “consumer report and/or investigative consumer report”) about me. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records.

I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to Emmanuel Faith Community Church, if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act.
Signature:*

Clear
Date:*

MonthDayYear
Date
Identifying Information for Background Information Agency (also known as “Consumer Reporting Agency”)
Email*
example@example.com
Print Name*
First, Middle & Last Name
Other Names Used (alias, maiden, nickname):
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date*

MonthDayYear
Approximate Move-In Date
Former Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date*

MonthDayYear
Approximate Move-In Date
Social Security Number*
Daytime Telephone Number:
Date of Birth:*

MonthDayYear
Date
Gender*
Should be Empty:

Permission to Obtain a Background Check

Identifying Information for Background Information Agency (also known as “Consumer Reporting Agency”)