HCS Background Check Form
Provide your personal details and consent to release information for the volunteer/employment background check.
Student Name(s)
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Full First Name
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Full Middle Name
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Full Last Name
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Maiden Name / Alias
Date of Birth
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Driver's License Number
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Driver's License State
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Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Authorization of Release of Information
I would like to volunteer or have applied for employment at Heritage Christian School. I authorize the school to investigate references, work records, evaluations, education, and other matters related to my suitability for employment or to volunteer. I understand the investigation may include criminal background checks with (but not limited to) the FBI and the Washington State Patrol. I authorize references, employers, and applicable agencies to disclose to Heritage Christian School employment records, performance reviews, letters, reports, and other information related to my life and employment, without giving me prior notice of such disclosure. In addition, I hereby release Heritage Christian School, employers, references, and all other parties from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. I agree that a photocopy or facsimile copy of this document and signature shall be considered as the original signed release on file. I waive any right I might have to inspect the references provided on my behalf.
Driver's License Photo
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I certify that I have carefully read and do accept the above statements.
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I certify that I have carefully read and do accept the above statements.
Signature
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Date
*
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Driver's license number and date of birth are required for Washington State Patrol background check purposes only. EQUAL OPPORTUNITY EMPLOYER: Heritage does not discriminate on the basis of race, color, national origin, veteran status, disability status or any other basis prohibited by federal, state or local law. Pursuant to the Civil Rights Act of 1964, Section 702 (42 U.S.C. 2000e 1(a)) HERITAGE CHRISTIAN SCHOOL (as a faith based organization) has the right to, and does hire only candidates who agree with HERITAGE CHRISTIAN SCHOOL'S Statement of Faith.
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