Hope Lutheran School Volunteer Background Check Authorization printable pdf download

VOLUNTEER BACKGROUND CHECK AUTHORIZATION

In an effort to create a safe environment for your children and our staff, we will require background checks for

our volunteers woriing directly with children. We have instituted this policy in light of what has been happening in

schools across the nation. Working with children includes but is not limited to being a chaperone, driving on field

trips, room moms, or teachers aids. We have the ability to run a background check through a system called

Protect My Ministry. Please return this form to the school office. All forms will be shredded after the background

is checked.

Name: ______________________________________________________________________

(First)

(Middle)

(Last)

Former Name(s) and Dates Used: ________________________________________________

Current Address Since: _________________________________________________________

(Mo/Yr)

(Street)

(City)

(Zip/State)

Previous Address From: ________________________________________________________

(Mo/Yr)

(Street)

(City)

(Zip/State)

Previous Address From: ________________________________________________________

(Mo/Yr)

(Street)

(City)

(Zip/State)

Social Security Number: _______________________

Telephone Number: __________________

Drivers License Number/State: __________________

Date of Birth: ________________________

The information contained in this application is correct to the best of my knowledge. I hereby authorize Hope Lutheran Church

and School and its designated agents and representatives to conduct a comprehensive review of my background causing a

consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I

understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following

areas: verification of social security number; current and previous residences; employment history, education background,

character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state,

county jurisdictions; driving records, birth records, and any other public records.

I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and

law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Hope Lutheran Church and

School o r its agents. I further authorize the complete release of any records or data pertaining to me which the individual,

company, firm, corporation, or public agency may have, to include information or data received from other sources.

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Hope Lutheran School Volunteer Background Check Authorization