Background Check Consent Form

Background Check Consent Form

As part of our volunteer application process, individuals age 18 and older must complete this form to authorize a background check. If you have questions about the background check process, please contact the Bay Area Human Resources team (hr@bayarea.church).
Screening Type (select all that apply):

Other
Full Legal Name:

First NameMiddle NameLast NameSuffix
Other Last Names Used (or N/A if none):
Preferred Name (if different):
Email Address:
example@example.com
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Home Address:

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Social Security Number:
xxx-xx-xxxx format
Date of Birth:
MM/DD/YYYY format
Gender:
Drivers License Number (or N/A):
Drivers License State of Issue (Or N/A):

CRIMINAL HISTORY DISCLOSURE QUESTIONS
1) PENDING CHARGES: Are you currently charged with, under indictment for, or awaiting trial for any criminal offense (other than minor traffic violations)?
1) PENDING CHARGES: If yes, please explain (include jurisdiction and nature of charge)
2) CRIMINAL CONVICTIONS: Have you ever been convicted of, pleaded guilty to, or pleaded no contest to a criminal offense (other than minor traffic violations)?
2) CRIMINAL CONVICTIONS: If yes, please explain (include date, jurisdiction, and nature of offense)
3) CRIMES INVOLVING MINORS OR ABUSE: Have you ever been convicted of, pleaded guilty to, or pleaded no contest to any offense involving: A minor; violence; sexual misconduct; abuse or neglect; and/or exploitation?
3) CRIMES INVOLVING MINORS OR ABUSE: If yes, please explain
4) DRIVING RECORD: If the volunteer role involves driving on behalf of the church or school - Have you had your driver's license suspended or revoked within the past five (5) years?
4) DRIVING RECORD: If yes, please explain

CRIMINAL HISTORY DISCLOSURE QUESTIONS