Background Check Authorization
Volunteer Form
Email address *
Name *
Your answer
Former Name (s) and Dates used
Your answer
Current Address: *
Your answer
How long have you lived here?
Example: 05/05/2003 - present
Your answer
Previous Address:
Your answer
When did you live here?
Example: 05/05/2000- 05/05/2003
Your answer
Previous Address:
Your answer
When did you live here?
Example: 05/05/1990- 05/05/2000
Your answer
Social Security Number *
*This is needed if you are volunteering with children (it is confidential)
Your answer
Birthday *
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Phone number
Your answer
Drivers License Number/ State: *
Your answer
The information contained in this application is correct to the best of my knowledge. I hereby authorize Towne South Church of Christ and it's designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/ or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number; credit reports, current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdiction; driving records, birth records, and any other public records. I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Towne South Church of Christ or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or date received from other sources. **Towne South Church of Christ and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant's personal information, including but not limited to , addresses, social security numbers, and dates of birth.
Electric Signature: (type below)
Your answer
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