Background Check Form

Background Check Form
Name
First Last
Cell Phone*
Email*
Are you 18 years or older?*
Date of Birth*
MM slash DD slash YYYY
References
SCC Reference - Please reference a current Southpoint  Community Church attendee (NOT employees or relatives).*
First Last
Email*
Phone*
Personal Reference*
First Last
Email*
Phone*
Relationship
Please read and agree to the following:
Consent*
By checking this box I contend that:
I have completed all the sections of this application. The information contained in this application is correct to the best of my knowledge. I authorize any references of churches listed in this application to give you any information they may have regarding my character and suitability for children's ministry. I release all such references from liability for any damage that may result from furnishing such evaluations to you and I waive any right that I have to inspect the references provided on my behalf. I have read the above qualifications and pledge to keep them to the very best of my ability. I understand that in completing this application, it does not guarantee me a volunteer position with Southpoint Community Church. Staff can choose to decline my submission for any reason. I also understand that, if I am approved to volunteer, my position can be terminated at any time by a staff member for any reason they deem appropriate. I understand that the above two actions will be taken for the safety of the children and I will support any decision Southpoint Community Church makes on my behalf regarding my volunteer services.
Signature
Date:*
Permission to Obtain a Background Check (For applicants 18 years and older)
Consent for Background Check*
By checking this box I contend that:
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 five years after requesting a background check. In the interest of safety and security I, the undersigned applicant (also known as "consumer"), authorize Southpoint Community Church through its independent contractor, Protect My Ministry, to procure background information (also known as a "consumer report and/or investigative consumer report") about me, prior to, and at any time during, my service to the organization. This report may include my driving history, including any traffic citations; a social security number verification; 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 Southpoint Community 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:*
Identifying Information for Background Information Agency
(also known as "Consumer Reporting Agency")
First Name*
Middle Name*
Last Name*
Other Names Used (alias, maiden, nickname):
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Former Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Social Security Number*
Daytime Phone Number*
Drivers' License Number*
State of Issuance*
Date of Birth*
MM slash DD slash YYYY
Gender*
- Male
- Female
*
- I understand that a background check report may be obtained for employment/volunteer purposes and give my authorization to obtain the report.

Background Check Form

References

Please read and agree to the following:

Permission to Obtain a Background Check (For applicants 18 years and older)

Identifying Information for Background Information Agency