PERMISSION TO OBTAIN A BACKGROUND CHECK
(This form authorizes the church to obtain background information and must be completed by the applicant. The church must keep this completed form on file for at least two years after requesting a background check.)
I, the undersigned applicant (also known as "consumer"), authorize Grace Fellowship Evangelical Free Church, to procure background information (also known as a "consumer report and/or investigative consumer report") about me. This report may include my driving history, including any traffic citations; a social security number ver- ification; present and former addresses; criminal and civil history/records; and the state sex offender records. I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to Grace Fellowship Evangelical Free Church, if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act.
Signature:
Date:
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Month
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Day
Year
Date
Identifying Information for Background Information Agency (also known as "Consumer Reporting Agency")
Print Name:
First Name
Middle Initial
Last Name
Other Names Used (alias, maiden, nickname):
Current Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Former Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Security Number:
Telephone Number:
Format: (000) 000-0000.
Driver's License Number:
State of Issuance:
Date of Birth:
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Month
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Day
Year
Date
Gender
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