Background Check Authorization

Name*

First NameMiddle NameLast NameSuffix

Address (not a PO Box)*

Street Address

Street Address Line 2

CityState

Zip Code

Date of Birth*

MonthDayYear

Phone Number*

Please enter a valid phone number.

Social Security Number*

Email

example@example.com

I, the applicant, agree with the following statement:*

I hereby certify that all the information that is provided in this consent form is true, correct and complete.I understand all Offers of Volunteer are contingent upon the applicant's successful completion, as determined by the employer's sole discretion, of this criminal history / background check.I do hereby consent to the church to use any information that is provided in this application to perform a criminal history check.The church has informed me that I have the right to review and challenge any negative information that would adversely impact a decision to offer volunteer work.I have been informed that I will have a reasonable opportunity to clear up any mistaken information reported within a reasonable time frame established within the sole discretion of the church.Under the Fair Credit Reporting Act, I have been advised that upon request I will be provided the name, address and phone number of the reporting agency as well as the nature, substance and source of all information.

Please Sign Below*