Background Check – Church Organizational Management

Background Check Authorization

ABC Community Church Authorization for Background Check
I authorize ABC Church to solicit background information relative to my criminal record history. I understand that ABC Church may make inquiries into my background that may include motor vehicle records, personal references, criminal records and any other public record reports pertaining to me. I authorize, without reservation, any person, agency, or other entity contacted by ABC Church, or their agent, for purposes of obtaining background report information to furnish the above-mentioned information. I release ABC Church, their respective employees, or agents, and employees of their agents and all persons, agencies and entities providing information or reports about me from any and all liability arising out of furnishing any such information.
Please Print
First Name:	Middle Name:	Last Name:
Other Names Used:
Social Security Number:		Date of Birth:
Current Address
Street Address:	City:	State: Zip:
How long at this address? Years/months:
Previous Address
Street Address:	City:	State: Zip:
How long at this address? Years/months:
Previous Address
Street Address:	City:	State: Zip:
How long at this address? Years/months:

Printed Name:	Signature:		Date:

Note: This document is meant to serve as an example form and should not be construed as a legal document. Please contact a legal professional for legal language for your specific organization.