Greene Background Check Consent Form

BACKGROUND CHECK CONSENT FORM

The Joint Recreation Committee Youth Sports Volunteer Program
The JRC is conducting a Background Check Program for all volunteer coaches who are 18 years or older whose position deals with the supervision of minors. We are not anticipating any problems but we are committed to maintaining a quality and safe environment for all of the youth athletes.

ALL APPLICATIONS AND RESIULTS WILL REMAIN CONFIDENTIAL
Full Legal Name*

First NameMiddle NameLast Name
Other Names (nicknames, maiden name, etc.)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Drivers Lic#*
State*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

List ALL states lived in since age 18 and dates of each residency:

BACKGROUND CHECK CONSENT FORM