Background Check Authorization

Central Christian School is a ministry of Central Presbyterian Church.
Background Check Authorization

Submission and storage of data contained in this form are confidential and encrypted.
The following best describes my role at Central Christian School*

Employee or Seeking EmploymentVolunteer or Chaperone
Name*

First NameMiddle NameLast Name
Maiden/Former Name(s)
Social Security Number*
Birthdate*

MonthDayYear
Date
Gender*

MaleFemale
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Driver's License Number*
Driver's License State of Issuance*
Addresses
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
At this address since*

MonthDayYear
Date
Previous Address (1)

Street Address

Street Address Line 2

CityState

Zip Code
At this address since

MonthDayYear
Date
Previous Address (2)

Street Address

Street Address Line 2

CityState

Zip Code
At this address since

MonthDayYear
Date

Education History

List all colleges attended
College (1)

Name

Street Address Line 2

CityState

Zip Code
Attendance dates from mm/yy to mm/yy .
Graduation date

MonthDayYear
Date
Name on graduation date

First NameLast Name
Major blanks Degree blank
College (2)

Name

Street Address Line 2

CityState

Zip Code
Attendance dates from mm/yy to mm/yy .
Graduation date

MonthDayYear
Date
Name on graduation date

First NameLast Name
Major blanks Degree blank
College (3)

Name

Street Address Line 2

CityState

Zip Code
Attendance dates from mm/yy to mm/yy .
Graduation date

MonthDayYear
Date
Name on graduation date

First NameLast Name
Major Degree
Other Names:*
If your education records might be filed under any other name/s, please list those names here; e.g. your maiden name. If there are no other names, put N/A.

Most Recent Employment
Employer Name
Phone
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Salary
Dates Employed: From blanks to blank .
Reason for Leaving
Employment Verification Authorization

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 employment and my discharge after employment.
Mark below to authorize Central Presbyterian Church or its agents to contact your current employer for Employment and Verification. Marking "I do authorize" will result in immediate inquiries to the Human Resource Department and to any listed supervisors or references in the Employment/Reference section of the application.
I do authorize you to do so.I do NOT authorize you to do so.
Signature (for employment verification)*

Clear
Printed Name*
Signed on*

MonthDayYear
Date

Background Check Authorization

The information contained in this application is correct to the best of my knowledge. I hereby authorize Central Presbyterian Church and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number, current and previous residences, employment history, education background, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions, driving records, birth records, and any other public records.
I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Central Presbyterian Church or its agents. I further authorize the complete release of any records or data pertaining to me to which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.
Central Presbyterian Church and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant's personal information, including, but not limited to, addresses, social security numbers, and dates of birth.
Signature (for Background Check)*

Clear
Printed Name*
Signed on*

MonthDayYear
Date
Should be Empty:

Central Christian School is a ministry of Central Presbyterian Church.

Background Check Authorization

Addresses

Education History

Most Recent Employment

Employment Verification Authorization

Background Check Authorization