Volunteer Background Check
Volunteer Background Check Request Form
Because we care about you, our children, and students we need to request your permission to perform a criminal records check. Please know that past mistakes will not necessarily negate you from ministry at the present time. However, in light of several recent court rulings, we now find it necessary to request your permission to obtain this information. Your cooperation with this request is greatly appreciated.
Electronic Signature:*
I hereby request the __________________ Police Department to release any information that pertains to any record of convictions contained in its files or in any criminal file maintained on me whether local, state, or national. I hereby release said police department from any and all liability resulting from such disclosure.
Local Police Department:*
If other, please list police department:
First, Middle and Last Name*
Maiden Name, all Aliases or Former Names (if applicable)*
Email Address:*
Main Phone Number:*
Date of Birth:*
Place of Birth:*
Social Security Number*
Today's Date:*
Initials: *