Background Check Authorization Form
All people who are working in Clothing INC are required to have a background check to continue volunteering. Please fill out the information requested on this form. By completing this form and submitting it, you are giving Clothing INC permission to conduct a complete back ground check.
Email address *
Last Name, First Name, Middle Intital *
Your answer
If you are you completing required hours select the agency you are completing them for. *
Former last name
Your answer
Other names used
Your answer
Gender *
Date of Birth *
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Race
Your answer
Street Address *
Your answer
City, State, Zip Code *
Your answer
Please read before submitting
I do hereby authorize a duly appointed representative from Clothing INC in Mt Pleasant, Michigan to verify the information on this form. Information on this form will be used for the express purpose of determining my suitability as a Clothing INC volunteer. I certify that I have made true, correct and complete answers and statements on this form. I agree to provide any further information that may be requested to complete this background check. I understand that this background check will remain valid for 2 years at which time I will complete another form.

I have the right to review the results of this background check.

I understand that Clothing INC's duly appointed representative will hold the results of this check in confidence and will not share this information with any other entities.

I understand and agree that any omission, false statement, misleading statement, or answer made by me on this form may be sufficient grounds for rejection as a volunteer or worker.
Please check what applies to you *
Required
Today's date *
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