Authorization for Background Check
In connection with my application for employment with Celebration Family Church, I authorize Celebration Family Church and/or PublicData.com or their agent, to solicit background information relative to my criminal record history. I understand that Celebration Family Church may conduct inquiries into my background that may include criminal records, personal references, and other public record reports pertaining to me.

I release Celebration Family Church, their respective employees, and PublicData.com, their agent and employees and all persons, agencies and entities providing information or reports about me from any and all liability arising out of furnishing any such information and reports.
Email address *
Full Legal Name *
Date of Birth *
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Current Age *
Sex *
AKA / Maiden Name *
Driver's License Number (Include Issuing State) *
Social Security Number *
Current Address (Include City, State, Zip) *
How long at this address? (Months/Years) *
Previous Address Current Address (Include City, State, Zip) *
How long at this address? (Months/Years) *
List all Cities and States resided in since the age of 18: *
Authorization Signature
Please Type Full Name *
Date *
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Submit
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