Arvada Covenant Church Children'S Ministries Adult Application Form (Page 3 of 3) in pdf

Arvada Covenant Church

Disclosure to Volunteer or Employment Applicant

Regarding Procurement of a Criminal Background Report

In connection with your application for employment or for a volunteer position at Arvada

Covenant Church, we may procure a criminal background check and/or DMV report on you as

part of the process of considering your candidacy. In the event that information from the report

is utilized in whole or in part in making an adverse decision with regard to your potential

employment or volunteer position, before making the adverse decision, we will provide you with

a copy of the report and discuss the results with you personally.

Please be advised that we may also obtain an investigative report including information as to

your character, general reputation, personal characteristics, and mode of living. This

information may be obtained by contacting your previous employers or references supplied by

you. Please be advised that you have the right to request, in writing, within a reasonable time,

that we make a complete and accurate disclosure of the nature and scope of the information

requested. Such disclosure will be made to you within 5 days lf the date on which we receive

the request from you or within 5 days of the time the report was first requested.

The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting

agencies such as the one used by Arvada Covenant Church to perform criminal background

checks and obtain DMV reports. You will be given a summary of these rights together with this

document.

By your signature below, you hereby authorize us to obtain a criminal background report, a

DMV report and/or an investigative report about you in order to consider you for employment or

for a volunteer position. This authorization is not valid for a consumer credit history report.

A copy of your current driver’s license must be attached to this form.

Applicant’s Full Legal Name:

(Please Print)

Applicant’s Address:

City:

State:

Zip Code:

Date of Birth: _____/_____/_____

Gender:

Male

Female

Signature:

______________________________________________

Today’s Date: _____/_____/_____

Circle the ministry you are applying for:

MOPS

Children’s

Jr. and/or Sr. High

Apartment Ministry

Arvada Covenant Church Children'S Ministries Adult Application Form Page 3