Information for Background Check: Personal Data

  • Information for Background Check: Personal Data

    Please fill out this form so we can perform a background check! This is required for all volunteers working with Partner families.
  • Date of Birth*
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  • Have you lived at the address listed above for longer than 7 years?*
  • Have you used any other names in the last 7 years?*

  • I UNDERSTAND THAT ALL VOLUNTEERS MUST PROVIDE THEIR CONSENT FOR A BACKGROUND CHECK WITH THE STATE DEPARTMENT OF HUMAN SERVICES CENTRAL CHILD ABUSE REGISTRY AND PROVIDE ANSWERS TO THE FOLLOWING QUESTIONS.

  • Has anyone ever brought or threatened to bring a civil or criminal claim against you alleging physical or sexual abuse or sexual harassment by you?*
  • Have you ever been accused, charged, or convicted of any law violation (except minor traffic offenses)?*
  • Has any employer ever disciplined you or terminated your employment or have you ever terminated your own employment for reasons related to physical or sexual abuse by you, sexual harassment by you, your unsafe driving, or your theft?*
  • Have you ever received any medical treatment, physical or psychological, for reasons involving physical abuse or sexual abuse by you?*

  • Applicant's Declaration, Authorization, and Release

  • My answers on this application that I have provided are complete and true. I understand that the submission of any false or incomplete information in connection with my application, whether on this or other documents or in interviews, will be cause for the rejection of my application or the dismissal of my volunteer service at any time. I authorize Partners in Housing and its agents to verify any information related to my application. I also authorize all individuals, schools, employers, and law enforcement officials to freely release any information concerning my background, and I hereby release any and all of them from any liability for doing so.

  • Are you over 18?*
  • Date
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  • Date
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  • DISCLOSURE AND AUTHORIZATION FORM TO OBTAIN CONSUMER REPORTS

    Please Read Carefully Before Signing the Authorization

  • DISCLOSURE

    In considering you for employment, services, or volunteering; or if you are employed, in considering you for subsequent promotion, assignment, reassignment, retention, or discipline, Partners in Housing, may request and rely upon one or more consumer reports or investigative consumer reports about you that we obtain from an agency, such as Elite Investigations.

    For explanation purposes:

    • Elite Investigations will utilize a variety of information it deems appropriate, which include, but are not limited to; current & former employers, criminal records, department of motor vehicle records, financial records to include credit reporting agencies, education records, both State & Federal licensing & sanctioning authorities, personal & professional references, an interview
      with the applicant by our office if so requested. I, agree, authorize and consent to the release & disclosure of any and all information including, but not limited to ____________, and Elite Investigations
    • a “consumer report” is a written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character,
      general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in making an employment-related decision about you. Such information may include, for example, credit information,
      criminal history reports, or motor vehicle records; and
    • an “investigative consumer report” is a consumer report in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your prior employers, neighbors, friends, or associates, or with others who may
      have knowledge concerning any such items of information. In the event an investigative consumer report is requested about you, you are entitled to additional disclosures regarding the nature and scope of the investigation requested, as well as a written summary of your rights under the
      Fair Credit Reporting Act (“FCRA”).

    Under the FCRA, before Partners in Housing can obtain a consumer report or investigative consumer report about you for employment purposes, we must have your written authorization. Before we take adverse action on the basis, in whole or in part, of information in that report, you will be provided a copy of that report, the name, and contact information of the consumer reporting agency, and a summary of your rights under the FCRA.

  • AUTHORIZATION

  • I have read and understand the foregoing Disclosure, and authorize Partners in Housing to obtain and rely upon consumer reports or investigative consumer reports in considering me for volunteering and, throughout my service, in considering me for assignment, reassignment, retention, or discipline. By my signature below, I authorize Partners in Housing to obtain any such reports and to share the information received with any person involved in the decision about me.

        authorize you to contact my current employer for Employment and Reference Verifications

    (This will authorize immediate inquiries to the Volunteer Coordination Department and to any listed supervisors or references in the Employment/Reference Section of your application.)   

    I also agree that this Disclosure and Authorization in original, faxed, photocopied, or electronic (including electronically signed) form will be valid for any consumer reports or investigative consumer reports that may be requested about me by or on behalf of the Company.

  • Date
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  • Date
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  • I have the right to make a request to Elite Investigations, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including sources of information, and the recipients of any reports on me which Elite Investigations has previously furnished within the two year period preceding myrequest.

    Elite Investigations
    6885 Mesa Ridge Parkway Suite. 199
    Fountain, CO. 80817
    E-mail: info@coeliteinvestigations.com
    Toll Free: (800) 817-1799

    I certify that all elements of the personal data I have provided are true, accurate and complete. I understand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any supplements to it and in any interviews will be sufficient grounds for rejection of volunteer service and my discharge after the start of my service.

  • Date*
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  • Please indicate if you would like to receive correspondence from Partners in Housing, to include, but not limited to, the agency newsletter, event invitations, and fundraising campaign mailings.
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