Background Check

NOTICE TO VOLUNTEERS REGARDING BACKGROUND INVESTIGATION

I understand that a consumer report (background screening report) and/or an investigative consumer report (reference checks and/or interviews) that may include information from public or private sources regarding my character, driving records, criminal history, court records (both civil and criminal), qualifications and experience, work habits, and/or other information relevant to my volunteer service may be obtained in connection with my application as a volunteer with Trinity Evangelical Free Church.

I understand that, if I am approved for volunteer service by Trinity Evangelical Free Church this background check authorization will be kept on file and may be used at any time during my service to procure further information when, in the judgment of Trinity Evangelical Free Church, such may be necessary.

I hereby release and discharge to the extent permitted by law, Trinity Evangelical Free Church, its employees, any individual or agency obtaining information for Trinity Evangelical Free Church, and any personal or professional reference, from any and all claims, damages, losses, liabilities, costs, or other expenses arising from the retrieving, reporting and/or disclosure of information in connection with this background investigation.

I understand that I am volunteering my services and declare in no way shall I be considered an employee or subcontractor or independent contractor of Trinity Evangelical Free Church.

By signing below, I’m indicating I have read, understand and consent to the above. I further authorize that a photographic copy or a telephonic facsimile of this document shall be valid for purposes present and future. My signature below certifies that all information I have provided in connection with this background check is true, accurate and complete to the best of my knowledge.

Authorization

Last Name*
First Name*
Middle*
Social Security Number*
Date of Birth*
MM slash DD slash YYYY
Drivers License Number*
Drivers License State*
Email*

Any other names I have been known by:

Name	Date of Change	Actions

There are no Names.

(including maiden name)

Current Address*
Street Address City State ZIP Code
Year Moved In*

Previous Addresses (list a total of 10 years):

Address	Year Moved In	Actions

There are no Addresses.

List all from the past 10 years.

Residents of Minnesota and Oklahoma only:*
- No - I do not want to receive a copy of any consumer report on me that is requested.
- Yes - I wish to receive a copy of any consumer report on me that is requested.
Under state law you have a right to receive a copy of your consumer report, free of charge, if one is required by Client. By checking the above box, a copy will be provided to you at the address you provide on this Disclosure and Authorization.
Applicant's Signature*
Date*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.