Background Check Disclosure and Authorization Form
PLEASE READ CAREFULLY
As a condition of my service to St. John’s Lutheran (“Client’) in Arnold, Missouri as an employee or as a volunteer, I understand that a criminal and sex offender report will be requested by Client from IntelliCorp Records, Inc. (“IntelliCorp”).

These reports may include information as to my character, general reputation, personal characteristics or mode of living, whichever are applicable. They may involve interviews with sources such as my neighbors, friends or associates. The report may also contain information about me relating to my criminal history, driving and/or motor vehicle records, social security number verification, verification of education or employment history, or other background checks. Such reports may be obtained at any time after receipt of this Disclosure and Authorization, as permitted by law and unless revoked by me in writing, throughout the course of my service to St. John’s Lutheran.

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you and to request a copy of your report.  These searches will be conducted by IntelliCorp Records, Inc., 3000 Auburn Drive, Suite 410, Beachwood, Ohio 44122; Tel. No. 1.888.946.8355; www.intellicorp.net.  
 
Acknowledgement and Authorization
By signing below, I voluntarily and knowingly authorize St. John’s Lutheran Church and School or its authorized agents to obtain or prepare criminal and/or sex offender reports or investigative consumer reports about me. I acknowledge receipt and certify that I have read this Disclosure and Authorization.

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Email *
I would like a copy of my report. *
By selecting yes, I voluntarily and knowingly authorize St. John's Lutheran Church and School or its authorized agents to obtain or prepare criminal and/or sex offender reports or investigative consumer reports about me. I acknowledge receipt and certify that I have read this Disclosure and Authorization. Checking yes acts as your signature. *
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