Rock Harbor Covenant Church, Inc.
Authorization of Background Check

I authorize Rock Harbor Covenant Church, Inc. to solicit background information relative to my criminal record history. I understand that Rock Harbor Covenant Church, Inc. may make inquiries into my background that may include motor vehicle records, personal references, criminal records, and any other public record reports pertaining to me.

I authorize, without any reservation, any person, agency, or other entity contacted by Rock Harbor Covenant Church, Inc. or their agent, for purposes of obtaining background report information to furnish the above-mentioned information.

I release Rock Harbor Covenant Church, Inc., their respective employees, or agents, and employees of their agents and all persons, agencies and entities providing information or reports about me from any and all liability arising out of furnishing any such information.


In connection with being a Volunteer with Rock Harbor Covenant Church, Inc. (the “Church”), notice is hereby given that a consumer report and/or investigative consumer report may be obtained from a consumer reporting agency for employment purposes. These reports may contain information about your character, general reputation, personal characteristics and mode of living, whichever are applicable. They may involve personal interviews with sources such as your neighbors, friends or associates. The reports may also contain information about you relating to your criminal history, credit history, driving and/or motor vehicle records, education or employment history, or other background checks.

You have the right, upon written request made within a reasonable time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report prepared by contacting the Church and Protect My Ministry 14499 N. Dale Mabry Hwy., Suite 201 South, Tampa, FL 33618; Phone: 1-800-319-5581. For information about Protect My Ministry’s privacy practices, see The scope of this notice and below authorization is not limited to the present and, if you are hired, will continue throughout the course of your employment and allow the Church to conduct future screenings for retention, promotion or reassignment, as permitted by law and unless revoked by you in writing.

A Note from Rock Harbor

The Church values your personal privacy and security. As soon as we enter the below information into Protect My Ministry for the search we will securely shred this document. We will never store this info.


By signing below I hereby authorize the obtaining of consumer reports and/or investigative consumer reports by the Church at any time after receipt of this authorization and throughout the course of my employment, if applicable.
Email address *
Full Legal Name *
Social Security Number *
Date of Birth *
Clear selection
Drivers License # *
Drivers License State *
Home Address *
**Is there a possibility that you will be serving in the Children’s Ministry? *
** We run a more extensive search on anyone that wants to be approved for serving with RKidz.
Signature (Type full name & date) *
Thank You for taking the time to complete this form and your willing to serve THROUGH Rock Harbor.
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