Background Check Authorization Form

It is our policy to perform a criminal/sexual background check every year on all volunteers over the age of 18. This form must be filled out and the background check completed before volunteering may begin.

For more information contact Patrice@kingstableministries.org.
www.kingstableministries.org

I hearby request and authorize the release of information which pertains to any record of convictions contained in law enforcement files or in any criminal file maintained on me whether local, state or national. I hereby release local state and national enforcement agencies from any liability resulting from such disclosure.

Background Check Consent

Please select all that apply.

Yes

Name

Middle Name

Maiden name or aliases

Address

Phone

This address will receive a confirmation email

Birthdate

Race/Ethnicity

Please select one option.

Asian or Pacific Islander Black or African American Hispanic or Latino Native American or Alaskan Native White or Caucasian Multiracial or Biracial Race/Ethnicity not listed

Gender

Please select all that apply.

Male Female

Electronic signature

Date

Please Note: A report concerning a crime related to assault, battery, abuse or sexual misconduct will automatically disqualify the applicant from ministry with children or youth. Any other reported misdemeanor or felony will be discussed with you and may be grounds for denial of an application to work with minors or vulnerable adults.

Background Check Authorization Form

Description

Please Fix the Following