FBC- Shelby Background Check Form
Please fill out the following information. The information in this for will be kept in confidentiality and only used to complete the appropriate background check requirements to serve with children and youth on the campus of First Baptist Church, Shelby, NC.
Name : (First, Middle and Last)
Your answer
Former Names: (First, Middle and Last and Dates Used)
Your answer
Current Address: (Include the Date You Started Residing Here - Mo/Yr)
Your answer
Previous Address: (Dates Residing - Mo/Yr)
Your answer
Previous Address: (Dates Residing - Mo/Yr)
Your answer
Social Security Number
Your answer
Date of Birth (Mo/Day/Year)
MM
/
DD
/
YYYY
Telephone Number
Your answer
Driver's License Number/State
Your answer
The information in the application is correct to the best of my knowledge. I hereby authorize First Baptist Church, Shelby NC and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report may include but is not limited to the following areas: history, education background, character references, drug testing, civil and criminal history records from any criminal justice agency in any or federal , state county jurisdictions; drivers 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 First Baptist Church, Shelby NC or it's agents. I further authorize the corporation, or public agency may have to include information or data received from to other sources. ***First Baptist Church, Shelby, NC and it designated agents and representatives shall maintain all information in a confidential manner in order to protect the applicants personal information, including but not limited to addresses, social security numbers and dates of birth.
Virtual Signature and Date (Mo/Day/Yr)
Your answer
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