Third Street Community Center Background Check Consent Form printable pdf download

Third Street Community Center Background Check Consent Form

Background Check Consent Form

I, _______________________________________ (print name), herby authorize Third Street

Community Center (Greenville, NC) and/or its agents to make an independent investigation of

my background, references, character, past employment, education, criminal or police

records, including those maintained by both public and private organizations and all public

records for the purpose of confirming the information contained on my job or volunteer

application and/or obtaining other information which may be material to my qualifications for

service and, if applicable, during the tenure of my service to the organization.

I release any organization or institution and any person or entity, which provides information

pursuant to this authorization, from any and all liabilities, claims or lawsuits in regards to the

information obtained from any and all of the above referenced sources used.

The following is my true and complete legal name and all information is true and correct to the

best of my knowledge.

Last Name: ______________________

First Name: __________________________

Maiden/Other Names: _________________

Middle Name: ________________________

Street Address: _______________________

How Long at Present Address?: __________

City: ______________________State: ________Zip: ____________Phone:________________

Email: ___________________________ Gender*: __ Male __ Female

Social Security Number: ______________________________

Date of Birth*: ___________

Signature of Candidate: _______________________________ Date: ___________________

TSCC Staff Signature: _________________________________

Date: ___________________

Third Street Community Center Background Check Consent Form