Genesis Metro Church - Background Consent
In connection with my application as a volunteer (or employee) with Genesis Metro Church. These consumer reports may include the following types of information: names and dates of previous employers, salary, work experience, education, accidents, licensure, credit (except California), etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, workers’ compensation claims, judgments, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records.

In addition, investigative consumer reports as defined by the federal Fair Credit Reporting Act, gathered from personal interviews with former employers and other past or current associates of mine to gather information regarding my work performance, character, general reputation and personal characteristics may be obtained.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY THE CONSUMER REPORTING AGENCY TO FURNISH THE ABOVE-MENTIONED INFORMATION

I have the right to make a request to the consumer reporting agency: AmericanChecked Inc., 4870 South Lewis Avenue, Suite 120, Tulsa, OK 74105; telephone: 800-975-9876 (“Agency”), upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information and the agency, on our behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by the investigative consumer report(s); and the recipients of any reports on me which the agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to your obtaining the above information from the agency. You may view their privacy policy at their website: www.americanchecked.com.

I hereby authorize procurement of background check(s). This authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my as a volunteer (or employee).I acknowledge that I have been provided a copy of consumer’s rights under the Fair Credit Reporting Act.

For purposes of gathering this information, I agree to supply the following information, which may be required by law enforcement agencies and other entities for positive identification purposes when checking records. It is confidential and will not be used for any other purpose.
First Name *
Last Name *
List any other names used
Current Address *
List Prior Cities and States Lived In During The Last 7 Years
Social Security # *
No Dashes
Date of Birth *
Format mm/dd/year
MM
/
DD
/
YYYY
Current Drivers License # *
Drivers License Issuing State *
Have you ever been convicted of any misdemeanor or felony? *
If yes, please explain and provide city, state and year.
Have you ever been arrested for abuse of a child, accused of physical assault or a sexual offense of any nature? *
If yes, please explain and provide city, state and year.
Phone Number *
Email Address *
Which ministry will you be serving in? *
Applicant Signature *
By typing your frst and last name you are agreeing to an electronic signature
Submit
Never submit passwords through Google Forms.
This form was created inside of Genesis Metro Church. Report Abuse