The information contained in this application is correct to the best of my knowledge. I acknowledge that a printed copy of this electronic submission shall be valid as the original. I authorize Champion Ministries/Groundwire to conduct a background check (NOT A CREDIT CHECK and NOT USING YOUR SOCIAL SECURITY NUMBER, which we will not request and do not want) to determine my ability to minister to teens and/or adults as a Spiritual Response Coach or Groundwire staff member. THE FAIR CREDIT REPORTING ACT, also known as Public Law 95-508, requires us to advise you that a routine inquiry may be made into your background which will provide applicable information concerning character, general reputation, personal characteristics and mode of living. Further information on the nature and scope of such report, if one is made, will be provided upon written request. Any offer of employment or volunteer work is contingent upon successfully passing a background check. I authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, Church, non-profit organization, reference, insurance company contacted by Champion Ministries dba Groundwire or its consumer reporting agency or its agent, to furnish the information described above. I release all such references from any liability for furnishing such evaluations to you, provided they do so in good faith and without malice. I understand that if any of the above records contain information which is used to deny my involvement as a Spiritual Response Coach and/or Groundwire staff member, that I will be notified of my rights and where I can obtain a copy of the information. I understand I will be issued a login and password and I agree I will not allow any other person to utilize my login and password. I understand the Coach Coordinator may disable my login at any time. I do hereby consent to my Groundwire email and live chats being monitored and/or saved and I acknowledge I may not be made aware of such monitoring and/or saving. I further state that I have carefully read the foregoing release and know the contents thereof. By typing my name in the signature box below I am agreeing to that being used as my signature of acceptance. (*)