Greene Background Check Consent Form

BACKGROUND CHECK CONSENT FORM

The Joint Recreation Commission 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.

ALL APPLICATIONS AND RESULTS 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:

I hereby authorize the JRC, to make inquiries as to my background including any information relating to my criminal records, or any other subjects that may, in the JRC's discretion, effect my ability to ensure the safety of minors.
Applicants Signature*

Clear
Date

MonthDayYear
Date
I am volunteer coach for:*
Should be Empty:

BACKGROUND CHECK CONSENT FORM