Background Check Consent Form - The Alley Church printable pdf download

Background Check Consent Form - The Alley Church

The Alley Church

Background Investigation Consent

I, ____________________________________ hereby authorize the Alley Church to make an independent investigation of

my criminal or police records for the purpose of confirming the information contained on this form and/or providing an

additional level of protection to myself, those with whom I serve and those we serve.

I release the Alley Church and/or its agents and any person who provides information pursuant to this authorization from

any liabilities, claims or lawsuits in regards to the information obtained from any of the above referenced sources.

The expiration of this authorization shall be for a period no longer than three years from the date of my signature.

The following is my true and complete legal name and all information is true and correct to the best of my knowledge:

Full Name (Printed)

Maiden Name or Other Names Used

____________________ ___________________ ______________________

_____________

Date of Birth

Social Security Number

Present Address

City/State

Zip

Former Address

(If you have lived at your current address for less than 3 years)

City/State

Zip

Signature

Date

Area of service __________________________ (nursery, Alleykids, women’s shelter, counting)

Email/phone __________________________________________________________________

Background Check Consent Form - The Alley Church