LIFEPOINTE CHURCH BACKGROUND CHECK

Permission form to run a background screening for volunteer purposes… I hereby authorize the release of any information which pertains to any record convictions contained in law enforcement files or in criminal files maintained on me, whether local, state, federal or military. I hereby release local, state, federal or military agencies from any and all liability resulting from such disclosure.

ALL FIELDS BELOW ARE REQUIRED

Name

First Name

Last Name

Middle

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Birth

Social Security #

Driver's License Number:

Driver's License State:

Driver's License expiration date:

APPLICANT'S STATEMENT

I certify that the answers given herein are true and complete to the best of my knowledge. I hereby release Lifepointe Church, and any authorized investigation agency used from any and all damages or claims arising either directly or indirectly as a result of this background check. If appointed, I understand that false or misleading information given in my application may lead to discharge. Should my application be accepted, I agree to follow the policies and procedures given to me. I understand that the information provided will be used only for the purpose of this background investigation. I further state that I HAVE CAREFULLY READ THE FORGOING RELEASE AND KNOW THE CONTENTS THEREOF AND SIGN THIS RELEASE OF MY OWN FREE ACT. This is a legally binding agreement I have read and understand.

First Name

Last Name

Date

YYYY

Background Check

LIFEPOINTE CHURCH BACKGROUND CHECK

ALL FIELDS BELOW ARE REQUIRED

lifepointe church