Background Check Authorization

For the safety and security of our students, all employees, volunteers, and chaperones must complete a background check before they can participate in school events.

Full Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Gender*

MaleFemale

Date of Birth*

Date

Phone Number*

Email*

example@example.com

Social Security Number*

Student(s) full name associated with this applicant*

Relationship to Student(s)*

Have you been apprehended, charged or convicted for a crime other than a moving traffic violation?*

YesNo

Are you on probation or parole?*

YesNo

Have you ever been convicted of child abuse?*

YesNo

If the answer is Yes to any of the questions above, please provide place, date and violation details below:

Do you have a valid driver's license?*

YesNo

Drivers License Number

State of Issue

Attach a picture of your driver's license

Browse Files

Do you have vehicle liability insurance?*

YesNo

Attach a copy of your insurance card

Browse Files

I hereby declare that the information submitted in this application is true and correct to the best of my knowledge. I understand that any false information will result in disqualifying this application. I hereby authorize Granville Christian Academy (GCA) and its representatives to perform an extensive review of my background based on private and public information I have provided for employment or volunteer purposes. I also authorized any agencies or background check companies to perform a background check investigation as part of my application. I fully understand that this investigation will generate a report that may include personal information, educational background, employment history, criminal history, and any other records. I, therefore, release and hold no harm to GCA and any representatives who provide this information from any liability.

Signature*

Date signed

Date

Background Check Fee

USD

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Background Check Authorization

Personal Information

Student Information

Criminal History

Driver Information

Payment Information