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Cornerstone Family Church Background Investigation Release Form
By entering my name in the electronic signature line below and submitting this form, I authorize Cornerstone Family Church (2925 Canoe Creek, Saint Cloud, Florida 34772) or its agent, to access all my relevant personal, criminal, or civil data required to complete a Background Investigation in accordance with the Department of Children and Families Handbook 7069 dated August 1, 2010. Authorization is further granted to any reporting agency to use a photo static reproduction of this authorization if necessary to release any information regarding the person named below.

The Background Investigation may contain information available in the Public Domain. I hereby release Cornerstone Family Church and all its agents and employees and any agencies releasing information from any and all liability resulting from furnishing this information to Cornerstone Family Church.

By submitting the information below, I hereby authorize all law enforcement agencies, city, state, county and federal courts and agencies, military services and persons to release all information they may have about me. This authorization shall be valid in original, photo static reproduction, or copy form.
Personal Information
Ministry You Want to Serve In *
LEGAL First Name *
LEGAL Middle Name *
LEGAL Last Name *
Maiden Name / Aliases / Nicknames *
Gender
Clear selection
Date of Birth - Month, Day, Year *
Social Security Number *
Driver's License Number *
State that Issued Driver's License *
Current Street Address *
City, State, and Zip Code *
Telephone / Cell Phone
Email
Electronic Signature *
Date
Cornerstone Family Church | 2925 Canoe Creek Rd. | Saint Cloud, FL 34772 | 407-892-3300
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