Uptown Church Background Check
The background check, references, and the questionnaire are all designed to provide a maximum of care for our children, youth and community. All information will be kept confidential and maintained in a secure file.
Email address *
Name (First Middle Last) *
Your answer
Please list any names used other than the one shown above (including maiden name) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Social Security Number *
Your answer
Current Address (Street, City, State, ZIP) *
Your answer
How long have you lived at this address? *
Your answer
Previous Address (Street, City, State, ZIP) *
Your answer
List all states in which you have resided for the previous 10 years *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Do you have any training/certification in first aid or CPR? *
Church history or previous experience *
Your answer
Are you currently a member at Uptown Church? *
Please list all other church(s) in which you have been a member of or attended on a regular basis *
Your answer
Have you ever volunteered at Uptown Church in the past? *
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